Management of patients with patent foramen ovale and cryptogenic stroke: A collaborative, multidisciplinary, position paper

Abstract

Available data provided the basis for a shared approach to management of cryptogenic ischemic cerebral events and PFO among different Italian scientific societies. Wider international initiatives on the topic are awaited.

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

“…In the first case, as in whichever cryptogenic stroke, some clinical aspects (i.e., Valsalva associated or on arousal symptoms, deep venous thrombosis, thrombophilia, or prothrombotic conditions) can give support to a correct etiopathogenic interpretation (38). The second scenario is still matter of debate because of the difficulty to distinguish PFO-related from non-PFO-related neuroimaging patterns although radiological findings such as superficial location, large size, and posterior circulation or superior cerebellar artery or deep frontal white matter involvement have been often proposed as solving clues (39)(40)(41)(42).…”

Young Paradoxical Stroke Treated Successfully with Mechanical Thrombectomy Using Solitaire and Transcatheter Closure of Patent Foramen Oval

“…23) Furthermore, the current recommendations on the management of patients with CS & PFO suggest that transcatheter PFO closure could be offered for patients at high risk of recurrent embolic event such as patients with atrial septal aneurysm, long PFO tunnel, substantial right-to-left shunt, eustachian valve, chiari network as well as hypercoagulable state. 24,25) Therefore, there was reasonable evidence to perform a transcatheter PFO closure in the young stroke patient because of a substantial right-to-left shunt.…”

Usefulness of intracardiac echocardiography with a mechanical probe for catheter‐based interventions: A 10‐year prospective registry

“…All the patients underwent TEE before the planned procedure, which was patent foramen ovale (PFO) closure in 368 patients and secundum atrial septal defect (ASD) closure in 169 patients (Table 1). 9 All patients with secundum ASD and/or PFO were investigated by transthoracic echocardiography (TTE) and TCD, respectively, before TEE. Inclusion criteria for percutaneous ASD closure included: Qp/ Qs > 1.5, enlargement of right atrium (>16.84 mm 2 area) and ventricle (inflow tract of right ventricle > 35 mm 2 ), 7 and ASD < 40 mm.…”