Is the search for right-to-left shunt still worthwhile?

Tanzi, Adrienne; Onorato, Eustaquio; Casilli, Francesco; Anzola, G. P.

doi:10.1111/ane.12456

Cited by 16 publications

(15 citation statements)

References 48 publications

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“…In conclusion, in spite of all the published data until today, we still do not have clear evidence-based recommendations for PFO closure [39, 40]. However, with the usage of new devices and recently published studies, PFO closure procedure is more beneficial than harmful.…”

Section: Discussionmentioning

confidence: 98%

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

Milev¹,

Zafirovska²,

Zimbakov³

et al. 2016

Open Access Maced J Med Sci

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BACKGROUND:Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine.AIM:Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO.MATERIAL AND METHODS:Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure.RESULTS:During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001).CONCLUSIONS:Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms.

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Section: Discussionmentioning

confidence: 98%

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

Milev¹,

Zafirovska²,

Zimbakov³

et al. 2016

Open Access Maced J Med Sci

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“…TCD diagnoses right-to-left atrial shunt (RLS) by detection of microbubbles (MB) passing through the middle cerebral artery. The threshold value of 42 MB during normal breathing was suggested to discriminate shunts related to stroke or TIA from a “bystander PFO” with no pathophysiological relationship to the symptoms ( 11 ). Both of the two cases in this report had considerably less than 42 MB (3 MB in case 1, and 17 MB in case 2) detected by TCD, and the RLS had no clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal Symptoms As the First Manifestation of Multiple Sclerosis Mimicking a Transient Ischemic Attack: A Report of Two Cases

et al. 2017

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Paroxysmal symptoms are unusual manifestations of multiple sclerosis (MS). When presented as the first clinical manifestation, paroxysmal symptoms may easily be mistaken for transient ischemic attack (TIA). Previously, several cases of MS that reported with paroxysmal symptoms were misdiagnosed as TIA. Here, we report two additional cases, focusing on the clinical characteristics of paroxysmal symptoms in MS. Both cases had paroxysmal symptoms as their first manifestation; one presented with transient dizziness, left face numbness, and right limb weakness, and the other presented with episodic lightheadedness, blurred vision, nausea, palpitations, and tremulousness upon standing. Both of the patients’ symptoms were mistaken for TIA at first, based on microembolic signals recorded by transcranial Doppler, but were later correctly diagnosed with MS based on neuroimaging and lumbar puncture. The paroxysmal symptoms responded to carbamazepine and were relieved completely after administration of intravenous methylprednisolone and interferon. Herein, we aim to summarize the differences between paroxysmal symptoms seen in MS and TIA, to facilitate a timely differential diagnosis and recommend an early appropriate treatment.

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“…Moreover, LA size has been correlated with ASA presence, multiple ischemic lesions and the RSL degree; LA diameter ≥43 mm and RoPE score>7 were significantly associated (29). Questions are also raised regarding the involvement of other R-L shunt sites (25).…”

Section: In Situ Clot Formationmentioning

confidence: 99%

“…R-L shunt can be detected in up to 100% of patients with PFO and history of embolism; 10% of PFO-related CS have large-degree R-L shunt (44,45). The shunt degree is significantly associated with stroke risk (both for index or recurrent event), as well as with TIA and migraines, while asymptomatic PFOs tend to be smaller (1,9,25,36,39,41,43). The incidence of stroke may be higher in the presence of significant shunt at rest (1).…”

Section: Shunt Degreementioning

confidence: 99%

“…Other studies report increased risk when the overlap between septum primum and septum secundum, often named "PFO length, " is deficient (25,35,43). Tunnel-like morphology, defined as ≥8-10 mm in length, was also reported as a high-risk factor, with OR for CS in the region of 2.66 (p = 0.017) (1,25,35,41). The discrepancy of whether a longer or shorter PFO is associated with embolic events may indicate differences in pathogenetic mechanisms.…”

Section: Morphologymentioning

confidence: 99%

See 1 more Smart Citation

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Ioannidis

Mitsias

2020

Front. Neurol.

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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 coexistence of other atrial abnormalities, such as right atrial septal pouch, Eustachian valve and Chiari's network. These may act independently or synergistically, multiplying the risk of embolic events. The RoPE score, a scale that includes factors such as young age, cortical infarct location and absence of traditional stroke risk factors, is associated with the probability of a PFO being pathogenic and stroke recurrence risk after the index stroke. Multiple investigators have attempted to correlate other PFO features with the risk of PFO-related stroke, but further investigation is needed before any robust conclusions are reached. PFO presence in young patients with cryptogenic stroke should be considered as etiologically suspect. Caution should be exercised in interpreting the relevance of other PFO features.

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Is the search for right-to-left shunt still worthwhile?

Cited by 16 publications

References 48 publications

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

Paroxysmal Symptoms As the First Manifestation of Multiple Sclerosis Mimicking a Transient Ischemic Attack: A Report of Two Cases

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

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