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.
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
Hematology
Ioannis A. Leventis, Dimitrios Sagris, Davide Strambo, Kalliopi Perlepe, Gaia Sirimarco, Stefania Nannoni, Eleni Korompoki, Efstathios Manios, Konstantinos Makaritsis, Konstantinos Vemmos, Patrik Michel, George Ntaios
Summary: The presence of atrial cardiopathy is inversely related to the presence of likely pathogenic PFO in patients with ESUS, with lower prevalence rates in ESUS patients compared to other conditions.
THROMBOSIS AND HAEMOSTASIS
(2021)
Article
Clinical Neurology
Keith Zhi Xian Toh, Ming Yi Koh, Jamie S. Y. Ho, Kathleen Hui Xin Ong, Yong Qin Lee, Xintong Chen, Jun Tao Fang, Elliot Yeung Chong, Isis Claire Z. Y. Lim, Yao Hao Teo, Yao Neng Teo, Christopher Y. K. Chua, Yinghao Lim, Bernard P. L. Chan, Vijay K. Sharma, Leonard L. L. Yeo, Ching Hui Sia, Benjamin Y. Q. Tan
Summary: In patients with embolic stroke of undetermined source (ESUS), a patent foramen ovale (PFO) may coexist with other potential embolic sources (PESs). This study found a high prevalence of concomitant PESs in ESUS patients with PFOs, which was associated with older age and a lower Risk of Paradoxical Embolism (RoPE) score.
CEREBROVASCULAR DISEASES
(2023)
Article
Clinical Neurology
Po-Lin Chen, Chi-Sheng Wang, Jin-An Huang, Yun-Ching Fu, Nien-Chen Liao, Chiann-Yi Hsu, Yu-Hsuan Wu
Summary: The efficacy and safety of patent foramen ovale (PFO) closure in non-elderly and elderly patients were investigated in this study. Results showed that closure of PFO was associated with a reduced risk of recurrent cerebral ischemic events and all-cause mortality in both non-elderly and elderly patients. Elderly patients with PFO closure also had a better functional outcome at 180 days. PFO closure might be considered in selected elderly patients with PFO.
FRONTIERS IN NEUROLOGY
(2023)
Review
Cardiac & Cardiovascular Systems
Jae-Kwan Song
Summary: Large randomized controlled trials have demonstrated the benefits of percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke and PFO. Recent studies have emphasized the clinical significance and prognostic implications of various anatomical features of PFO and the adjacent atrial septum. Transthoracic echocardiography with contrast study indirectly diagnoses PFO, while transesophageal echocardiography (TEE) provides a direct demonstration of PFO and enables detailed anatomical assessment. TEE also aids in the diagnosis of pulmonary arteriovenous malformation, a rare cause of paradoxical embolism. This review supports TEE as a useful screening test and highlights the importance of cardiac imaging specialists in the evaluation of patients with cryptogenic stroke.
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY
(2023)
Article
Cardiac & Cardiovascular Systems
Julio I. Farjat-Pasos, Paul Guedeney, Christine Houde, Alberto Alperi, Mathieu Robichaud, Melanie Cote, Gilles Montalescot, Josep Rodes-Cabau
Summary: There are sex differences in patients with cryptogenic cerebrovascular events undergoing patent foramen ovale (PFO) closure. Women are younger and have a higher risk score for paradoxical embolism. After follow-up, there are no differences in stroke events, but women have a higher rate of combined cerebrovascular events and bleeding complications.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Article
Biochemistry & Molecular Biology
Johanna Haertl, Maria Berndt, Holger Poppert, Friederike Liesche-Starnecker, Katja Steiger, Silke Wunderlich, Tobias Boeckh-Behrens, Benno Ikenberg
Summary: Although it is difficult to prove the pathophysiological impact of a patent foramen ovale (PFO) in individual patient care, it is considered to be of high relevance for secondary prophylaxis in selected patients with cryptogenic ischemic stroke. This study aimed to enhance the understanding of PFO attributable ischemic strokes by quantifying the histological clot composition. The results showed that the clot composition varied depending on the presence of a PFO, supporting the concept that a PFO may be of pathophysiological relevance in cryptogenic ischemic stroke.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Review
Medicine, General & Internal
Fabiana Luca, Paolo G. Pino, Iris Parrini, Stefania Angela Di Fusco, Roberto Ceravolo, Andrea Madeo, Angelo Leone, Mark La Mair, Francesco Antonio Benedetto, Carmine Riccio, Fabrizio Oliva, Furio Colivicchi, Michele Massimo Gulizia, Sandro Gelsomino
Summary: Patent foramen ovale (PFO) is a common cardiac abnormality associated with cryptogenic stroke and systemic embolization. Percutaneous PFO device closure (PPFOC) is recommended for young patients with large shunts and interatrial septal aneurysms. However, the selection criteria for PFO closure treatment are still uncertain. This review aims to update and clarify which patients should be considered for closure treatment.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Yuxuan Lou, Yang Hua, Jing Shi, Fengze Yang, Yifei Wang, Yang Yang, Wei Sun, Xiangqing Kong, Hao Zhang
Summary: This study compared the efficacy and safety of different Amplatzer models and similar occluders in the treatment of PFO. The results showed that asymmetric occluders provided better short-term occlusion and improvement in migraine symptoms compared to symmetric occluders.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2023)
Article
Peripheral Vascular Disease
Kentaro Ishizuka, Sono Toi, Takao Hoshino, Eiko Higuchi, Kazuo Kitagawa
Summary: This study investigated the relationship between infarct patterns and PFO in patients with ESUS and found that infratentorial lesions were independently associated with PFO. The presence of infratentorial lesions could predict the presence of PFO in ESUS cases.
JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS
(2022)
Article
Clinical Neurology
Aenne S. von Falkenhausen, Katharina Feil, Moritz F. Sinner, Sonja Schoenecker, Johanna Mueller, Johannes Wischmann, Elodie Eiffener, Sebastian Clauss, Sven Poli, Khouloud Poli, Christine S. Zuern, Ulf Ziemann, Jorg Berrouschot, Alkisti Kitsiou, Wolf-Rudiger Schaebitz, Marianne Dieterich, Steffen Massberg, Stefan Kaeaeb, Lars Kellert
Summary: This study introduces a novel non-invasive method for assessing the risk of atrial fibrillation (AF) after embolic strokes of undetermined source (ESUS) using digital electrocardiogram recordings. The results indicate that rhythm irregularity burden is the strongest predictor of AF. This research helps determine the risk of AF in ESUS patients and guide AF detection.
ANNALS OF NEUROLOGY
(2023)
Article
Neurosciences
George Ntaios, Dimitrios Sagris, Davide Strambo, Kalliopi Perlepe, Gaia Sirimarco, Georgios Georgiopoulos, Stefania Nannoni, Eleni Korompoki, Efstathios Manios, Konstantinos Makaritsis, Konstantinos Vemmos, Patrik Michel
Summary: In patients with ESUS, the presence of carotid atherosclerosis is inversely related to the presence of likely pathogenic PFO.
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
(2021)
Article
Medicine, General & Internal
Isis Claire Z. Y. Lim, Yao Hao Teo, Jun Tao Fang, Yao Neng Teo, Jamie S. Y. Ho, Yong Qin Lee, Xintong Chen, Kathleen Hui-Xin Ong, Aloysius S. T. Leow, Andrew Fu-Wah Ho, Yinghao Lim, Ting Ting Low, Ivandito Kuntjoro, Leonard L. L. Yeo, Ching-Hui Sia, Vijay K. K. Sharma, Benjamin Y. Q. Tan
Summary: In this cohort study, it was found that large right-to-left shunt (RLS) size in medically-managed PFO patients with cryptogenic stroke was significantly associated with an increased risk of recurrent stroke events.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Clinical Neurology
Hui Zhang, Haiyan Tang, Fei Wu, Chun Yu, Qiang Dong, Wenjie Cao
Summary: A MEAD score system incorporating TTE findings and patient characteristics can predict the presence of PFO in ESUS patients, with ARd>33mm, Em < 72 cm/s, and absence of diabetes history being key predictors. This score system can help increase diagnostic yield of PFO after ESUS.