Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: An Update

Abdelghani, Mohammad; Elshedoudy, Sahar; Nassif, Martina; Bouma, Berto J.; Winter, Robbert J. de

doi:10.1159/000501028

Cited by 40 publications

(50 citation statements)

References 68 publications

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“…Until recently, PFO closure was not considered a risk reducing procedure for recurrent stroke [29,[38][39][40]. New trials in 2017-2018 questioned this policy and suggested considering PFO closure in addition to lifelong antiplatelet treatment in selected patients [41,42]. These results may again raise the yield of TEE in upcoming years.…”

Section: Discussionmentioning

confidence: 99%

The effect of TEE on treatment change in patients with acute ischemic stroke

et al. 2020

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Background and purpose Ischemic stroke is a widespread disease carrying high morbidity and mortality. Transesophageal echocardiography (TEE) is considered an important tool in the work-up of patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients; its utility is limited by a semi-invasive nature. The purpose of this study was to evaluate the probability of treatment change due to TEE findings (yield) in the work-up of AIS and TIA patients. Methods Retrospective data on patients with AIS or TIA who underwent TEE examination between 2000–2013 were collected from the institutional registry. Results The average age of 1284 patients who were included in the study was 57±10.4, 66% of patients were male. The most frequent TEE findings included aortic plaques in 54% and patent foramen ovale (PFO) in 15%. TEE findings led to treatment change in 135 (10.5%) patients; anticoagulant treatment was initiated in 110 of them (81%). Most common etiology for switch to anticoagulation was aortic plaques (71 patients); PFO was second most common reason (26 patients). Significant TEE findings (thrombus, endocarditis, tumor) were found in 1.9% of patients, they were more common in young patients (<55; 56% of the patients). Conclusions The beginning of anticoagulation treatment in patients with thick and complicated plaques was found frequently in our study. Significant TEE findings, were infrequent, constituted an absolute indication for treatment change and were more common in younger patients.

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Section: Discussionmentioning

confidence: 99%

The effect of TEE on treatment change in patients with acute ischemic stroke

et al. 2020

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“…One feared outcome of venous thromboembolism in the setting of patent foramen ovale (PFO) is paradoxical stroke (4). The present report describes a novel case of concomitant aspiration thrombectomy and PFO closure in a patient with a right atrial thrombus and paradoxical embolic stroke.…”

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confidence: 87%

Concomitant AngioVac thrombectomy and patent foramen ovale closure in a patient with a large right atrial thrombus and recent paradoxical embolic stroke

Callese

Yang

Levi

et al. 2021

Diagn Interv Radiol

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“…Since the development of percutaneous device closure of PFO as a potential therapeutic option in this group of patients, PFO closure is known to be beneficial as compared to medical therapy in the preventions of recurrent neurological events [ 3 ]. The role of echocardiography is very important both in the diagnosis of PFO and in the evaluation of PFO for transcatheter closure [ 4 , 5 ]. Transesophageal echocardiography (TEE) is considered the gold standard for the diagnosis of PFO because it provides anatomical details [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and prognosis of patients with cryptogenic stroke and suggestive of patent foramen ovale

Choi

Kang

Jun

et al. 2021

Cardiovasc Ultrasound

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Aims The purpose of this study were to identify the usefulness of screening for PFO using agitated saline echocardiography (ASE) and characteristics and prognosis of patients with suggestive of patent foramen ovale (PFO). Methods Three hundred three patients (mean age, 53 ± 9 years; 199 [66%] men) admitted with acute stroke or suspicion of stroke were included. Patients were classified into those with and without right-to-left shunt (RLS) according to the ASE results (positive ASE [n = 92] vs. negative ASE [n = 211]). Fifty-one out of ninety-two patients with positive ASE and twenty-one out of two hundred eleven patients with negative ASE underwent TEE with ASE to confirm PFO. Results Ninety-two were positive for ASE and thirty-six of the fifty-one patients who underwent TEE were confirmed as having PFO. Of the patients with RLS grade 1, 50% were diagnosed with PFO and all patients with RLS grade ≥ 2 were diagnosed with PFO. All patients with negative ASE had no PFO (sensitivity of 100% and specificity of 58%). Patients with positive ASE were younger, had a lower body mass, and a lower prevalence of hypertension. The positive ASE patients had a higher mean Sʹ velocity and better diastolic function. Four of ninety-one patients with positive ASE and thirteen of one hundred seventy-seven showed recurrence of stroke and suspicion of stroke. Conclusion Transthoracic ASE is a good method to screen for PFO. Patients with suggestive of PFO had lower risk factors, less atherosclerosis, and better cardiac performance.

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Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: An Update

Cited by 40 publications

References 68 publications

The effect of TEE on treatment change in patients with acute ischemic stroke

The effect of TEE on treatment change in patients with acute ischemic stroke

Concomitant AngioVac thrombectomy and patent foramen ovale closure in a patient with a large right atrial thrombus and recent paradoxical embolic stroke

Characteristics and prognosis of patients with cryptogenic stroke and suggestive of patent foramen ovale

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