Patent Foramen Ovale as a Risk Factor for Cryptogenic Stroke

Approximately 40% of ischemic strokes have no clearly definable etiology and are termed cryptogenic strokes. Patent foramen ovale, a small communication between the left and right atria, is considered to be a risk factor for cerebral embolism. In this study, we report the case of a 29-year-old woman with diagnosis of ischemic stroke due to patent foramen ovale who has undergone percutaneous endovascular closure. The aim of this report is to discuss the relevant aspects of the patent foramen ovale and the cryptogenic stroke, its clinical presentation, diagnosis, management and recurrence.

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A Case Series Coexistence of PFO with Other Conditions - Who’s the Culprit?

Indonesian Journal of Cardiology ◽

10.30701/ijc.1155 ◽

2021 ◽

Vol 42 (3) ◽

Author(s):

Dessytha Nathania Hudaja ◽

Aurea Stella Soetjipto ◽

Queen Sugih Ariyani ◽

Michael Soesanto ◽

Ingrid Maria Pardede

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Patent Foramen Ovale ◽

Protein C ◽

Cryptogenic Stroke ◽

Case Series ◽

Review Article ◽

Foramen Ovale ◽

S Deficiency

Abstract. Background: Patent foramen ovale (PFO) is a major cause of cryptogenic stroke (CS). However, it is still possible that PFO comes with those other conditions during evaluation. This paper presents a series of CS cases highly suspected due to PFO origin with each of its special presentations. Case illustration/summary of a review article: We present three cases of CS with PFO as a possible contributing factor. Case 1 showed a patient with repeated ischemic strokes that was investigated to be cryptogenic in origin. Case 2 showed CS with PFO and occult atrial fibrillation. Case 3 showed CS at a young age caused by a PFO with protein C/S deficiency. Conclusion: The role of PFO as a culprit, risk factor, or a coincidental finding in CS is still debatable and is a controversial issue. Determining PFO as a cause of CS requires a thorough consideration of clinical and PFO anatomical/morphological factors.

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728 Different outcome after percutaneous closure of a patent foramen ovale or medical treatment to prevent cryptogenic stroke

European Heart Journal ◽

10.1016/s0195-668x(03)94136-4 ◽

2003 ◽

Vol 24 (5) ◽

pp. 130

Author(s):

M SCHROOTEN

Keyword(s):

Medical Treatment ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Percutaneous Closure ◽

Foramen Ovale

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Stroke Prophylaxis by Percutaneous Closure of Patent Foramen Ovale and Left Atrial Appendage

Interventional Cardiology Review ◽

10.15420/icr.2011.6.1.67 ◽

2011 ◽

Vol 6 (1) ◽

pp. 67

Author(s):

Antonio L Bartorelli ◽

Claudio Tondo ◽

◽

Keyword(s):

Left Atrial ◽

Patent Foramen Ovale ◽

Stroke Risk ◽

Left Atrial Appendage ◽

Cryptogenic Stroke ◽

Atrial Appendage ◽

Foramen Ovale ◽

Percutaneous Procedures ◽

Cerebrovascular Events

Innovative percutaneous procedures for stroke prevention have emerged in the last two decades. Transcatheter closure of the patent foramen ovale (PFO) is performed in patients who suffered a cryptogenic stroke or a transient ischaemic attach (TIA) in order to prevent recurrence of thromboembolic events. Percutaneous occlusion of the left atrial appendage (LAA) has been introduced to reduce stroke risk in patients with atrial fibrillation (AF). The role of PFO and LAA in the occurrence of cerebrovascular events and the interventional device-based therapies to occlude the PFO and LAA are discussed.

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Faculty Opinions recommendation of Closure or medical therapy for cryptogenic stroke with patent foramen ovale.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267257.15779440 ◽

2012 ◽

Author(s):

Philippa Newfield

Keyword(s):

Medical Therapy ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale

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Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

Cardiovascular & Hematological Agents in Medicinal Chemistry ◽

10.2174/1871525718666200203111641 ◽

2020 ◽

Vol 18 (2) ◽

pp. 135-150

Author(s):

Harsha S. Nagarajarao ◽

Chandra P. Ojha ◽

Archana Kedar ◽

Debabrata Mukherjee

Keyword(s):

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Narrow Channel ◽

Paradoxical Embolism ◽

Current Evidence ◽

Foramen Ovale ◽

The Right ◽

The Relationship ◽

Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

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Impact on actual clinical practice of the latest evidence for percutaneous closure of patent foramen ovale associated with stroke. A single center experience

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.089 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

L Carnero Montoro ◽

M Ruiz Ortiz ◽

N Paredes Hurtado ◽

M Delgado Ortega ◽

A Rodriguez Almodovar ◽

...

Keyword(s):

Clinical Trials ◽

Clinical Practice ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Percutaneous Closure ◽

Publication Date ◽

Foramen Ovale ◽

Complex Anatomy ◽

The Mean ◽

The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background and aims Since september 14th, 2017. Three large clinical trials demonstrated that, in selected patients, percutaneous closure of patent foramen ovale (PFO) was associated with lower recurrence in patients with cryptogenic stroke (CS). Our aim was to determine the impact of these findings on routine clinical practice in a tertiary hospital. Methods Patients with percutaneous closure of PFO due to CS (January 2001-January 2020) were included. The clinical characteristics were analyzed individually and grouped in the RoPE score, before and after the publication date. Complex anatomy (CA) defined as interatrial septum aneurysm or basal wide bubble passage was evaluated in both periods. Results 293 patients were included. The mean age was 49 ± 11 years, 15% were older than 60 years, 60% men, 26% hypertensive, 28% smokers and 7%diabetics. The median RoPEscore was 6 [p25-75, 5-7] and 75% met CA criteria. Since september 14th, 2017, the frequency of CA and the mean age of the patients were significantly higher (89% vs. 69% p <0.0005 and 51 ± 11 vs. 48 ± 11 years, p = 0.02, respectively), and RoPEscore, significantly lower (5 [5-7] vs. 6 [5-7], p = 0.02). Conclusion The publication of clinical trials wich demonstrated the benefit of percutaneous closure of PFO in CS had a significant impact on the daily clinical practice of our institution, with an increase in indications for CA, despite a clinical profile suggestive of lower causal probability of PFO.

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