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Propensity Score-Matched Analysis of Lesion Patterns in Stroke Patients With Patent Foramen Ovale and Patients With Spontaneous Intracranial Artery Dissection
Conclusion: The present study suggests that lesion patterns observed from DWI of patients with PFO and SIAD might provide clues to the etiology of infarcts. Single lesions (cortical or subcortical) might be a typical feature of PFO associated strokes, while multiple lesions in one vascular territory might be a specific feature of SIAD associated strokes. Introduction Both patent foramen ovale (PFO) and spontaneous intracranial artery dissection (SIAD) are important stroke risk factors, especially in young and middle-aged adults (1–3). About 25% of patients with ischemic stroke are cryptogenic (4), and PFO is ...
Source: Frontiers in Neurology - April 23, 2019 Category: Neurology Source Type: research

ADAMTS-13 activity in stroke of known and unknown cause: Relation to vascular risk factor burden
ConclusionADAMTS-13 activity is inversely correlated with the number of vascular risk factors across different stroke etiologies. Further study is warranted to establish ADAMTS-13 as a mediator of cerebrovascular risk.
Source: Frontiers in Neurology - January 10, 2023 Category: Neurology Source Type: research

Who Should Rather Undergo Transesophageal Echocardiography to Determine Stroke Etiology: Young or Elderly Stroke Patients?
Conclusions: TEE was highly valuable for determining stroke etiology and influenced individual secondary prevention based on available treatment guidelines and expert opinion in most cases. In young patients the impact of TEE was limited to the detection of septal anomalies. By contrast, in older patients TEE detected high numbers of complex aortic atheroma and potential indicators of paroxysmal atrial fibrillation.
Source: Frontiers in Neurology - December 18, 2020 Category: Neurology Source Type: research

Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors
Conclusion: In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.
Source: Frontiers in Neurology - June 3, 2020 Category: Neurology Source Type: research

Association Between Patent Foramen Ovale and Overt Ischemic Stroke in Children With Sickle Cell Disease
This study investigates the association between PFO and overt ischemic stroke in the DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study cohort of 5,247 children with SCA of whom 1,414 had at least one clinical non-contrast transthoracic echocardiogram. Presence of PFO was taken from the clinical report. Further, we assessed the association between PFO and other clinical and hemolytic factors in children with SCA such as history of abnormal sickle stroke screen [elevated Transcranial Doppler ultrasound (TCD) velocity] and patient's baseline hemoglobin. In 642 children for ...
Source: Frontiers in Neurology - December 13, 2021 Category: Neurology Source Type: research

A Nomogram for Predicting Patent Foramen Ovale-Related Stroke Recurrence
ConclusionsNomogram 1, based on Hcy, hsCRP, and ALB levels, provided a more clinically realistic prognostic prediction for patients with PFO-related stroke. This model could help patients with PFO-related stroke to facilitate personalized prognostic evaluations.
Source: Frontiers in Neurology - June 9, 2022 Category: Neurology Source Type: research

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?
Patent foramen ovale (PFO) has been associated with cryptogenic stroke. There is conflicting data and it remains uncertain whether PFO is the direct cause, a risk factor or an incidental finding. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signaling disruption. Main risk factors linked with PFO-attributable strokes are young age, PFO size, right-to-left shunt degree, PFO morphology, presence of atrial septal aneurysm, intrinsic coagulation-anticoagulation systems imbalance, and co-existen...
Source: Frontiers in Neurology - June 24, 2020 Category: Neurology Source Type: research

Current Challenges and Future Directions in Handling Stroke Patients With Patent Foramen Ovale —A Brief Review
The role of patent foramen ovale (PFO) in stroke was debated for decades. Randomized clinical trials (RCTs) have shown fewer recurrent events after PFO closure in patients with cryptogenic stroke (CS). However, in clinical practice, treating stroke patients with coexisting PFO raises some questions. This brief review summarizes current knowledge and challenges in handling stroke patients with PFO and identifies issues for future research. The rationale for PFO closure was initially based on the concept of paradoxical embolism from deep vein thrombosis (DVT). However, RCTs did not consider such details, limiting their impac...
Source: Frontiers in Neurology - April 28, 2022 Category: Neurology Source Type: research

Differences in clinical and biological factors between patients with PFO-related stroke and patients with PFO and no cerebral vascular events
We present a study concerning clinical, demographic, and laboratory factors associated with stroke and transient ischemic attack in patients with patent foramen ovale (PFO), as well as comparing PFO-patients with and without cerebrovascular ischemic events (CVEs).Patients and methodsConsecutive patients with PFO-associated CVEs were included in the study; control group was selected from patients with a PFO and no history of stroke. All participants underwent peripheral routine blood analyses, as well as, on treating physician's recommendations, screening for thrombophilia.ResultsNinety-five patients with CVEs and 41 contro...
Source: Frontiers in Neurology - March 14, 2023 Category: Neurology Source Type: research

Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale —A Review of the Literature
Conclusion: VTE can be detected in patients with CS linked to PFO. While –based on the presented literature–routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.
Source: Frontiers in Neurology - May 4, 2020 Category: Neurology Source Type: research

A Narrative and Critical Review of Randomized-Controlled Clinical Trials on Patent Foramen Ovale Closure for Reducing the Risk of Stroke Recurrence
Patent foramen ovale (PFO) is a common cardiac anatomic variant that has been increasingly found in young (<60 years) cryptogenic stroke patients. Despite initial neutral randomized-controlled clinical trials (RCTs), there have been four recent RCTs providing consistent data in favor of the efficacy and safety of PFO closure compared to medical therapy for secondary stroke prevention. However, taking into consideration the high prevalence of PFO, the low risk of stroke recurrence under medical treatment and the uncommon yet severe adverse events of the intervention, patient selection is crucial for attaining meaningful ...
Source: Frontiers in Neurology - June 3, 2020 Category: Neurology Source Type: research

Presence of Atrial Fibrillation in Stroke Patients With Patent Foramen Ovale: Systematic Review and Meta-Analysis
Conclusion: The presence of a PFO in patients with ischemic stroke/TIA may be associated with a lower risk of AF. Few studies have estimated the risk of future AF in patients with PFO.
Source: Frontiers in Neurology - April 15, 2021 Category: Neurology Source Type: research

Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review
Conclusions: Given the limitations of autopsy and TEE studies, there is good reason not to take a fixed 25% PFO prevalence for granted. The estimation of degree of causality may be underestimated or overestimated in populations with PFO prevalence significantly lower or higher than the established. Given the high sensitivity, non-invasive nature, low cost, and repeatability of TCD, future large-scale TCD-based studies should investigate potential heterogeneity in PFO prevalence in different healthy racial/ethnic populations.
Source: Frontiers in Neurology - April 27, 2020 Category: Neurology Source Type: research

Bubble Test and Carotid Ultrasound to Guide Indication of Transesophageal Echocardiography in Young Patients With Stroke
ConclusionsBubble test and carotid ultrasound could be used for the individual decision for/against TEE in patients with cryptogenic stroke ≤60 years. If they are unremarkable, TEE can be omitted with high safety regarding secondary prevention. If bubble test is positive and/or carotid ultrasound shows atherosclerosis, TEE should be carried out if PFO or aortic atheroma are potentially relevant for further patient management.
Source: Frontiers in Neurology - March 4, 2022 Category: Neurology Source Type: research

Utility of Transthoracic Echocardiography in Diagnostic Evaluation of Ischemic Stroke
Conclusion: Our findings suggest that despite widespread use, the overall yield of TTE in AIS is low. Stratifying patients according to their likelihood of benefitting from it will be important toward better resource utilization.
Source: Frontiers in Neurology - February 17, 2020 Category: Neurology Source Type: research

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