Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

Abstract

OBJECTIVE: Although its role is a matter of debate, some studies described a higher prevalence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in young stroke patients, with higher risk with PFO / ASA association (OR 4.96). The aim of this study was determine the prevalence of PFO and ASA in a cohort of cryptogenic ischemic stroke (IS) patients younger than 55 years and to follow-up after surgical or percutaneous endovascular closure (PEC). METHOD: In 21 months we identified all patients less than 55 years old with IS who were admitted to our hospital. Cryptogenic IS was considered if there is not an identifiably cause to cerebral ischemia. Transesophageal echocardiography (TEE) was performed in all patients. After interatrial septal abnormalities diagnosis, percutaneous device closure was offered to all. Patients were followed monthly and keeped with oral AAS or Clopidogrel. RESULTS: We identified 189 patients with IS and 32 were less than 55 years old (16.9%). In 29 the IS was cryptogenic. TEE was performed in all patients and some form of interatrial septal abnormality was identified in 12 (12/29 - 41.3%); 5 had a PFO and in 7 there was PFO plus ASA. Ten patients were submitted to PEC and 2 were submitted to surgical closure. In mid-term follow-up (28 months) no ischemic events occurred and 2 patients related disappearance of migraine symptoms. CONCLUSION: Our small series description is in accordance with other studies and suggests a possible relation between interatrial septal abnormalities and IS in a cohort of young patient.

Transesophageal echocardiography in patients with cryptogenic ischemic stroke: A systematic review

“…A total of 260 articles were identified in the initial search, of which 27 (n = 5,653) met our eligibility criteria, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][38][39][40][41]7,[42][43][44][45]11,[46][47][48][49][50][51][52] including 18 subcohorts in group A (b55 years, n = 2,360) and 20 subcohorts in group B (≥55 years or age unselected, n = 3,293). online Appendix Supplementary Table II summarizes the characteristics of the study populations.…”

Ischemic stroke and patent foramen ovale: case report

“…Depending on the criteria used for diagnosis and the technology used in cardiac assessment, the prevalence of PFO in the healthy population is approximately 20-25% 3,[5][6][7][8] . Thus, detection of a PFO during evaluation of a patient with a stroke is not surprising, and the frequency of PFO detection in these patients can be as high as 40-45% 9 .…”

“…Silva et al 8 identified 29 cryptogenic ischemic strokes in their group of patients younger than 55. Fortyone point three percent of these patients had some form of interatrial septal abnormality.…”

“…Surgical or endovascular closure could be the best option in very young patients if we consider the risks of a lifelong anticoagulation or antiplatelet therapy 8,23,24 . Mechanical closure of the PFO has been proposed as the definite way to prevent recurrent paradoxical embolism.…”

Posicionamento da Sociedade Brasileira de Cardiologia e da Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista sobre Centro de Treinamento e Certificação Profissional em Hemodinâmica e Cardiologia Intervencionista – 2020

“…9 Epidemiological data, however, have established a clear relation between PFO and stroke of undetermined origin. [10][11][12][13][14] Additionally, studies have documented higher rates of systemic embolization among patients who have venous thrombosis or debris and concomitant PFO. [15][16][17][18] Many reports have also demonstrated direct evidence of thrombi adherent to the PFO.…”