Review
Anesthesiology
Gael Rais, Paola Vassallo, Raoul Schorer, Bernardo Bollen Pinto, Alessandro Putzu
Summary: This study found a significant association between patent foramen ovale (PFO) and perioperative stroke in noncardiac surgery through a systematic review and meta-analysis. The presence of PFO was independently associated with an increased risk of stroke, with varying risks across different surgical specialties. Prospective trials should further investigate this association and identify specific high-risk populations.
BRITISH JOURNAL OF ANAESTHESIA
(2022)
Article
Clinical Neurology
Hans-Christoph Diener, Aurauma Chutinet, J. Donald Easton, Christopher B. Granger, Eva Kleine, Lars Marquardt, Juliane Meyerhoff, Andrea Zini, Ralph L. Sacco
Summary: There is no significant difference in preventing ischemic stroke between anticoagulant and antiplatelet therapy in ESUS patients with PFO. Currently, there is insufficient evidence to recommend anticoagulation over antiplatelet therapy for this patient population.
Review
Clinical Neurology
Scott E. Kasner, Simona Lattanzi, Ana Catarina Fonseca, Akram Y. Elgendy
Summary: This study summarizes the available data on the benefits of patent foramen ovale closure over medical therapy for patients who have had a stroke attributed to the patent foramen ovale. Despite uncertainties and controversies in patient selection, pathophysiology, diagnosis, and treatment, this study aims to provide clarification and future directions for clinicians and investigators.
Article
Cardiac & Cardiovascular Systems
Luca Testa, Antonio Rubbio, Mattia Squillace, Flavio Albano, Vincenzo Cesario, Matteo Casenghi, Giuseppe Tarantini, Paolo Pagnotta, Alfonso Ielasi, Grigore Popusoi, Leonardo Paloscia, Alessandro Durante, Diego Maffeo, Francesco Meucci, Giuliano Valentini, Gian Paolo Ussia, Paolo Cioffi, Bernardo Cortese, Giuseppe Sangiorgi, Gaetano Contegiacomo, Francesco Bedogni
Summary: This is an Italian multi-center registry study evaluating the efficacy and safety of PFO closure with the Cocoon PFO Occluder. The results demonstrate successful closure of PFO with minimal complications and satisfactory mid-term clinical outcomes.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2023)
Review
Cardiac & Cardiovascular Systems
Davor Vukadinovic, Bruno Scheller, Christian Ukena, Sebastian Ewen, Felix Mahfoud, Michael Bohm
Summary: There is a significant difference in the risk of AF after PFO closure between Amplatzer PFO Occluder and GORE Occluder, with the former having a lower incidence rate. However, these findings need to be validated in a large-scale randomized clinical trial.
CLINICAL RESEARCH IN CARDIOLOGY
(2022)
Article
Hematology
K. Lacut, E. Le Moigne, F. Couturaud, C. Font, F. J. Vazquez, I Canas, J. A. Diaz-Peromingo, A. Gil-Diaz, E. Bucherini, M. Monreal
Summary: An increased risk of ischemic stroke was found in acute pulmonary embolism patients with patent foramen ovale (PFO). Patients with PFO were more likely to have chronic heart failure, prior myocardial infarction or ischemic stroke, and had a higher rate of subsequent ischemic stroke than those without PFO. Further investigation is needed before determining the best therapeutic option in these patients.
THROMBOSIS RESEARCH
(2021)
Article
Clinical Neurology
Davide Strambo, Gaia Sirimarco, Stefania Nannoni, Kalliopi Perlepe, George Ntaios, Kostantinos Vemmos, Patrik Michel
Summary: The study verifies the effectiveness of the RoPE score in predicting the presence/absence of PFO in ESUS patients and suggests that the RoPE score is helpful in distinguishing between pathogenic and incidental PFOs. Factors such as left ventricular hypertrophy, atherosclerosis, and infratentorial stroke may enhance the score, while lower RoPE scores are associated with more incidental atrial fibrillation during a 10-year follow-up.
Article
Cardiac & Cardiovascular Systems
Dominik Jurczyk, Sascha Macherey-Meyer, Elias Rawish, Thomas Stiermaier, Ingo Eitel, Christian Frerker, Tobias Schmidt
Summary: This study aimed to determine the incidence rates of new-onset atrial fibrillation (AF) after percutaneous closure of patent foramen ovale (PFO) and investigate the differences due to various screening strategies and devices. The meta-analysis showed that percutaneous PFO closure led to a higher incidence of AF compared to conservative treatment. However, the heterogeneity in surveillance and follow-up strategies limited the generalizability of the findings.
CLINICAL RESEARCH IN CARDIOLOGY
(2023)
Review
Cardiac & Cardiovascular Systems
Arun Chockalingam, Nariman Nezami, Nikitha Murali, Hamid Mojibian, Jeffrey S. Pollak, Clifford R. Weiss
Summary: For high-risk patients with pulmonary embolism, catheter-directed therapies such as thrombolysis and thrombectomy can be considered. The treatment approach for patients with both a PFO and acute pulmonary embolism should be carefully selected, possibly requiring surgical embolectomy or PFO closure.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2021)
Review
Clinical Neurology
Leonardo Varotto, Gianni Bregolin, Mariemma Paccanaro, Antonella De Boni, Carlo Bonanno, Francesco Perini
Summary: Systematic reviews suggest that PFO closure is effective in preventing strokes compared to medical therapy, but may increase the risk of atrial fibrillation.
NEUROLOGICAL SCIENCES
(2021)
Editorial Material
Cardiac & Cardiovascular Systems
Chadi Allam, Zeina Kadri, Rabih Azar
Summary: An 86-year-old man with end-stage renal disease presented with thrombosis of his arteriovenous fistula during a hemodialysis session. After undergoing surgical thrombectomy, he suffered from peripheral embolization and livedo reticularis. Echocardiograms revealed large thrombi in the right atrium prolapsing to the left atrium via a patent foramen ovale, and another thrombus adherent to the apical wall of the right ventricle, with intermittent crossing of the mitral valve and entering the left ventricle.
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES
(2021)
Review
Clinical Neurology
Ting-Ting Liu, Rong-Hong Jiao, Tao Chen, Zhi-An Jiang, Wen-Lou Bai
Summary: This study aimed to investigate the presence of a residual shunt in patients who have experienced cryptogenic cerebrovascular events following a PFO closure. The analysis indicated a marked difference in the recurrence of cerebrovascular events between residual shunt (RS) cases and non-RS cases, suggesting that RS may be a risk factor for recurrent cerebrovascular events in patients that experienced PFO-related cerebrovascular events within 6 months after PFO closure surgery.
CEREBROVASCULAR DISEASES
(2023)
Editorial Material
Public, Environmental & Occupational Health
Magdalena Sawicka, Robert K. Szymczak
Summary: The article presents a case of stroke in a young woman trekking in the Himalayas and discusses the importance of paradoxical embolism in the diagnosis of high-altitude cerebral edema.
JOURNAL OF TRAVEL MEDICINE
(2022)
Article
Clinical Neurology
Jessie Ze-Jun Chen, Vincent N. Thijs
Summary: The study found a higher frequency of atrial fibrillation (AF) post-percutaneous closure of patent foramen ovale (PFO), with the risk concentrated in the first 45 days post-procedure and increasing with patient age.
Article
Cardiac & Cardiovascular Systems
Jakub Honek, Martin Sramek, Tomas Honek, Ales Tomek, Ludek Sefc, Jaroslav Januska, Jiri Fiedler, Martin Horvath, Stepan Novotny, Marek Brabec, Josef Veselka
Summary: This study evaluated the occurrence of decompression sickness (DCS) after the implementation of a patent foramen ovale (PFO) screening and risk stratification strategy. The results showed that the transcranial color-coded sonography screening and risk stratification strategy could reduce the risk of DCS in divers with PFO. Catheter-based PFO closure had a similar DCS occurrence as the control group, and the conservative strategy had a similar effect in the low-grade group but a higher incidence in the high-grade group compared to other groups.
JACC-CARDIOVASCULAR IMAGING
(2022)
Article
Clinical Neurology
Eleni Karantali, Konstantinos Vemmos, Evangelos Tsampalas, Konstantinos Xynos, Persefoni Karachalia, Dimitrios Lambrou, Stella Angeloglou, Maria Kazakou, Aikaterini Karagianni, Konstantina Aravantinou-Fatorou, Eleftheria Karakatsani, Michiel L. Bots, Georgia Karamatzianni, Stavros Bellos, Romanos Ntiloudis, Maria Lypiridou, Anastasia Gamvoula, Georgios Georgiopoulos, Erold Ajdini, Nikolaos Gatselis, Konstantinos Makaritsis, Eleni Korompoki, George Ntaios
Summary: This population-based study in southern Greece found a significant decline in stroke incidence and mortality rates between 1993 and 2016.
INTERNATIONAL JOURNAL OF STROKE
(2022)
Article
Cardiac & Cardiovascular Systems
Alberto Aimo, Iacopo Fabiani, Alberto Giannoni, Giulia Elena Mandoli, Maria Concetta Pastore, Giuseppe Vergaro, Valentina Spini, Vladyslav Chubuchny, Emilio Maria Pasanisi, Christina Petersen, Elisa Poggianti, Claudia Taddei, Vincenzo Castiglione, Sara Latrofa, Giorgia Panichella, Carlotta Sciaccaluga, Georgios Georgiopoulos, Claudio Passino, Matteo Cameli, Michele Emdin
Summary: Cardiac amyloidosis (CA) affects all four heart chambers, and strain parameters of all chambers are altered in CA patients, particularly those with amyloid transthyretin (ATTR; n = 144, 34%) or amyloid light-chain (AL; n = 117, 28%) CA. Peak left atrial longitudinal strain (LA-PALS) is independently associated with the diagnosis of CA or ATTR-CA beyond standard echocardiographic variables and cardiac biomarkers. Patients with the most severe impairment of LA strain are most likely to have CA or ATTR-CA.
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
(2022)
Review
Clinical Neurology
Weijia Li, Jiyoung Seo, Damianos G. Kokkinidis, Leonidas Palaiodimos, Sanjana Nagraj, Eleni Korompoki, Haralambos Milionis, Wolfram Doehner, Gregory Y. H. Lip, George Ntaios
Summary: The use of oral anticoagulation therapy in patients with heart failure and sinus rhythm can reduce the occurrence of stroke, but it also increases the risk of major bleeding. Rivaroxaban has a better effect in preventing stroke, but it is also associated with a higher risk of bleeding. There were no significant differences between the use of oral anticoagulants and the control group in terms of myocardial infarction, all-cause mortality, and hospitalization for heart failure.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Review
Clinical Neurology
Hans-Christoph Diener, Rolf Wachter, Andrew Wong, Vincent Thijs, Renate B. Schnabel, George Ntaios, Scott Kasner, Peter M. Rothwell, Rod Passman, Jeffrey L. Saver, Bert A. Albers, Richard A. Bernstein
Summary: This narrative review provides an overview of cardiac rhythm monitoring in patients with cryptogenic stroke (CS) who are being considered for percutaneous patent foramen ovale (PFO) closure. It discusses current practices, stroke recurrences, findings from monitoring studies, and predictors for atrial fibrillation (AF) detection in CS patients. The review proposes a personalized strategy for cardiac monitoring in CS patients, taking into account the likelihood of AF detection and high-risk PFO features.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Review
Pharmacology & Pharmacy
Muath Alobaida, Gregory Y. H. Lip, Deirdre A. Lane, Dimitrios Sagris, Andrew Hill, Stephanie L. Harrison
Summary: This review provides an overview of studies on the clinical outcomes of endovascular thrombectomy (EVT) in patients with ischemic stroke, including the impact of EVT on patients with and without atrial fibrillation (AF), the effect of adjunctive pharmacological therapies, and the integration of prehospital care on EVT outcomes. The evidence on the effect of AF on EVT outcomes and the safety and efficacy of AF treatment during EVT is limited.
EXPERT OPINION ON PHARMACOTHERAPY
(2023)
Article
Clinical Neurology
Joao Pedro Marto, Davide N. Strambo, George Ntaios, Thanh Nguyen, Roman Herzig, Anna Czlonkowska, Jelle Demeestere, Ossama Yassin Mansour, Alexander Salerno, Susanne W. Wegener, Philipp Baumgartner, Carlo Cereda, Giovanni Bianco, Morin Beyeler, Marcel Arnold, Emmanuel Carrera, Paolo Machi, Valerian Altersberger, Leo Bonati, Henrik Gensicke, Manuel Bolognese, Nils Peters, Stephan Wetzel, Marta Magrico, Joao Nuno Ramos, Joao Sargento-Freitas, Rita Machado, Carolina Maia, Egidio Machado, Ana Paiva Nunes, Patricia Ferreira, Teresa Pinho e Melo, Mariana Carvalho Dias, Andre Paula, Manuel Alberto Correia, Pedro Castro, Elsa Azevedo, Luis Albuquerque, Jose Nuno Alves, Joana Ferreira-Pinto, Torcato Meira, Liliana Pereira, Miguel Rodrigues, Andre Pinho Araujo, Marta Rodrigues, Mariana Rocha, Angelo Pereira-Fonseca, Luis Ribeiro, Ricardo Varela, Sofia Malheiro, Manuel Cappellari, Cecilia Zivelonghi, Giulia Sajeva, Andrea Zini, Mauro Gentile, Stefano Forlivesi, Ludovica Migliaccio, Maria Sessa, Sara La Gioia, Alessandro Pezzini, Davide Sangalli, Marialuisa Zedde, Rosario Pascarella, Carlo Ferrarese, Simone Beretta, Susanna Diamanti, Ghil Schwarz, Giovanni Frisullo, Simona Marcheselli, Pierre Seners, Candice Sabben, Simon Escalard, Michel Piotin, Benjamin Maier, Guillaume Charbonnier, Fabrice Vuillier, Loic R. Legris, Pauline Cuisenier, Francesca Vodret, Gaultier Marnat, Jean-Sebastien Liegey, Igor Sibon, Fabian Flottmann, Gabriel O. Broocks, Nils-Ole Gloyer, Ferdinand Bohmann, Jan Hendrik J. Schaefer, Christian Nolte, Heinrich Audebert, Eberhard Siebert, Marek Sykora, Wilfried Lang, Julia Ferrari, Lukas Mayer-Suess, Michael Knoflach, Elke Ruth J. Gizewski, Jeffrey M. Stolp, Lotte Stolze, Jonathan Coutinho, Paul Nederkoorn, Ido van den Wijngaard, Joke De Meris, Robin Lemmens, Sylvie De Raedt, Fenne Vandervorst, Matthieu Pierre Rutgers, Antoine Guilmot, Anne Dusart, Flavio Bellante, Patricia Calleja-Castano, Fernando Ostos, Guillermo Gonzalez-Ortega, Paloma Martin-Jimenez, Sebastian Garcia-Madrona, Antonio Cruz-Culebras, Rocio Vera, Maria Consuelo Matute, Blanca Fuentes, Maria Alonso-de-Lecinana, Ricardo Rigual, Exuperio Diez-Tejedor, Soledad Perez-Sanchez, Joan Montaner, Fernando Diaz-Otero, Natalia Perez-de-la-Ossa, Belen Flores-Pina, Lucia Munoz-Narbona, Angel Chamorro, Alejandro Rodriguez-Vazquez, Arturo Renu, Oscar Ayo-Martin, Francisco Hernandez-Fernandez, Tomas Segura, Herbert Tejada-Meza, Daniel Sagarra-Mur, Marta Serrano-Ponz, Thant Hlaing, Isaiah See, Robert Simister, David Werring, Espen Saxhaug Kristoffersen, Annika Nordanstig, Katarina Jood, Alexandros Rentzos, Libor Simunek, Dagmar Krajickova, Antonin Krajina, Robert Mikulik, Martina Cvikova, Jan Vinklarek, David Skoloudik, Martin Roubec, Eva Hurtikova, Rostislav Hruby, Svatopluk Ostry, Ondrej Skoda, Marek Pernicka, Lubomir Jurak, Zuzana Eichlova, Martin Jira, Martin Kovar, Michal Pansky, Pavel Mencl, Hana Palouskova, Ales Tomek, Petr Jansky, Anna Olserova, Martin Sramek, Roman Havlicek, Petr Maly, Lukas Trakal, Jan Fiksa, Matej Slovak, Michal Adam Karlinski, Maciej Nowak, Halina Sienkiewicz-Jarosz, Anna Bochynska, Pawel Wrona, Tomasz Homa, Katarzyna Sawczynska, Agnieszka Slowik, Ewa Wlodarczyk, Marcin Wiacek, Izabella Tomaszewska-Lampart, Bartosz Sieczkowski, Halina Bartosik-Psujek, Marta Bilik, Anna Bandzarewicz, Malgorzata Dorobek, Justyna Zielinska-Turek, Marta Nowakowska-Kotas, Krystian Obara, Pawel Urbanowski, Slawomir Budrewicz, Maciej Guzinski, Milena Switonska, Iwona Rutkowska, Paulina M. Sobieszak-Skura, Beata Labuz-Roszak, Aleksander Debiec, Jacek Staszewski, Adam Stepien, Jacek Zwiernik, Grzegorz Wasilewski, Cristina Tiu, Elena Oana Terecoasa, Razvan Alexandru Radu, Anca Negrila, Bogdan Dorobat, Cristina Panea, Vlad Tiu, Simona Petrescu, Atilla Ozdemir, Mostafa Mahmoud, Hussam El-Samahy, Hazem Abdelkhalek, Jasem Al-Hashel, Ismail Ibrahim Ismail, Athari Salmeen, Abdoreza Ghoreishi, Sergiu Ionut Sabetay, Hana Gross, Piers Klein, Mohamad Abdalkader, Pascal Jabbour, Kareem El Naamani, Stavropoula Tjoumakaris, Rawad A. Abbas, Ghada Mohamed, Alex Chebl, Jiangyong Min, Majesta P. Hovingh, Jenney Tsai, Muhib Khan, Krishna Nalleballe, Sanjeeva Onteddu, Hesham Masoud, Mina Michael, Navreet Kaur, Laith G. Maali, Michael Abraham, Priyank Khandelwal, Ivo Bach, Melody Ong, Denis M. Babici, Ayaz Khawaja, Maryam Hakemi, Kumar Rajamani, Vanessa Cano-Nigenda, Antonio Arauz, Pablo Amaya, Natalia Llanos, Akemi Arango, Miguel Angel Vences, Jose Dominguo Barrientos Guerra, Rayllene Caetano, Rodrigo Targa Martins, Sergio Daniel Scollo, Patrick Matic Yalung, Shashank Nagendra, Abhijit Gaikwad, Kwon-Duk Seo, Georgios G. Georgiopoulos, Raul Nogueira, Patrik Michel
Summary: This retrospective study evaluated the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. COVID-19 patients had higher rates of intracranial bleeding complications and worse clinical outcomes after treatment compared to non-COVID-19 patients.
Review
Cardiac & Cardiovascular Systems
Sylvia E. Choi, Dimitrios Sagris, Andrew Hill, Gregory Y. H. Lip, Azmil H. Abdul-Rahim
Summary: Stroke is a major cause of death and disability worldwide. Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is expected to reach epidemic proportions. AF is associated with a five-fold increase in stroke risk, and strokes caused by AF are often more severe. Despite significant reduction in stroke incidence due to oral anticoagulation, AF is believed to contribute to a significant portion of cryptogenic strokes.
EXPERT REVIEW OF CARDIOVASCULAR THERAPY
(2023)
Article
Cardiac & Cardiovascular Systems
George Ntaios, Dimitrios Sagris, Benjamin J. R. Buckley, Stephanie L. Harrison, Azmil Abdul-Rahim, Philip Austin, Gregory Y. H. Lip
Summary: This study aimed to investigate whether there is a difference in the risk of cardiovascular events, including acute myocardial infarction and ischemic stroke, between individuals with first-diagnosed paroxysmal AF treated with anticoagulants and those with non-paroxysmal AF. The results showed that individuals with paroxysmal AF had a higher risk of acute myocardial infarction, while there was no significant association between the type of AF and risk of ischemic stroke.
Review
Cardiac & Cardiovascular Systems
Hizir Ozdemir, Dimitrios Sagris, Gregory Y. H. Lip, Azmil H. Abdul-Rahim
Summary: The purpose of this review is to summarize the association between atrial fibrillation and ischemic stroke, and provide insights on the pathophysiological mechanisms and clinical management of patients with atrial fibrillation in order to reduce the burden of ischemic stroke.
CURRENT CARDIOLOGY REPORTS
(2023)
Article
Clinical Neurology
Dan Wang, Zi-Yang Shang, Yu Cui, Ben-Qiang Yang, George Ntaios, Hui-Sheng Chen
Summary: This study used 3.0 T high-resolution MRI to investigate the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source. The results showed that intracranial plaque proximal to LVO was more common on the ipsilateral side to stroke and had larger plaque burden, higher remodelling index, higher percentage of lipid-rich necrotic core, higher prevalence of discontinuity of plaque surface, fibrous cap rupture, intraplaque haemorrhage and complicated plaque. Logistic analysis revealed that remodelling index and plaque burden were positively associated with ischaemic stroke. In the subgroup with <50% stenotic plaque, higher plaque burden, remodelling index, percentage of lipid-rich necrotic core and presence of complicated plaque were more closely related to stroke.
STROKE AND VASCULAR NEUROLOGY
(2023)
Review
Health Care Sciences & Services
Spyros Peppas, Leonidas Palaiodimos, Sanjana Nagraj, Damianos G. Kokkinidis, Nidhish Tiwari, Amrin Kharawala, Mohammad K. Mojadidi, Sanauallah Mojaddedi, George Ntaios, Robert T. Faillace, Jonathan M. Tobis
Summary: The aim of this study was to assess the association between the presence of a right-to-left shunt (RLS) and neurological decompression sickness (NDCS) and asymptomatic brain lesions among otherwise healthy divers. The results showed that high-grade RLS is associated with a greater risk of NDCS, but the association with asymptomatic brain lesions is not statistically significant.
Review
Clinical Neurology
Natallia Khenkina, Alberto Aimo, Iacopo Fabiani, Pier Giorgio Masci, Dimitrios Sagris, Steven E. Williams, George Mavraganis, Hui-Sheng Chen, Max Wintermark, Patrik Michel, George Ntaios, Georgios Georgiopoulos
Summary: This article reviews the use of magnetic resonance imaging (MRI) in identifying cardiac and vascular embolic sources in ESUS patients and evaluates the reclassification value of MRI examinations in the conventional ESUS diagnostic process. The results show that MRI techniques can identify additional cardiac and vascular embolic sources, potentially decreasing the prevalence of ESUS diagnoses.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Review
Clinical Neurology
Dimitrios Sagris, George Ntaios, Haralampos Milionis
Summary: Patients with ischaemic stroke have multiple cardiovascular risk factors, and in addition to antithrombotic therapy, assessing and treating these risk factors is crucial for reducing mortality and morbidity. Dyslipidaemia, diabetes mellitus, and hypertension are common modifiable risk factors that, when recognized and treated early, can significantly lower the risk of major cardiovascular events. Recent advancements in pharmacological treatment, combined with improved adherence, persistence, and lifestyle modifications, have the potential to alleviate the burden of cardiovascular disease in patients who have experienced ischaemic strokes.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2023)
Article
Mathematical & Computational Biology
Konstantinos Pateras, Eleftherios Meletis, Matthew Denwood, Paolo Eusebi, Polychronis Kostoulas
Summary: This manuscript introduces a modified version of the Epidemic Volatility Index called cEVI, which serves as an early warning tool for emerging epidemic waves. It performs well in predicting early and intermediate epidemic waves and maintains a warning during an epidemic wave. The combination of cEVI with the original index results in higher accuracy, and integrating multiple warning systems can enable early implementation of optimal outbreak interventions.
INFECTIOUS DISEASE MODELLING
(2023)