Prognosis after stroke followed by surgical closure of patent foramen ovale

Devuyst, G.; Bogousslavsky, Julien; Ruchat, Patrick; Jeanrenaud, Xavier; Despland, P. A.; Régli, F; Aebischer, Nicole; Karpuz, Hakan; Castillo, Veronica; Guffi, Michel; Sadeghi, H

doi:10.1212/wnl.47.5.1162

Cited by 144 publications

(72 citation statements)

References 16 publications

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“…It is noteworthy that these patients were considered at high risk because of a "large" shunt or multiple ischaemic lesions. In the initial experience with surgical closure, Devuyst et al reported no recurrent event in 32 patients [22], but papers by Homma et al (19.5% recurrence rate at 13 months) and the Mayo Clinic (7.5% at 1 year and 16.6% at 4 years) were disappointing [23,24]. Surgery has been superseded by the percutaneous transcatheteral approach due to the absence of open-heart surgery [25].…”

Section: Discussionmentioning

confidence: 99%

Recurrent cerebrovascular ischaemic events in patients with interatrial septal abnormalities: a follow-up study

et al. 2006

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The aim of this study was to evaluate the risk of recurrent ischaemic cerebrovascular events (stroke or transient ischaemic attack (TIA)) in patients with patent foramen ovale (PFO) or atrial septal aneurysm (ASA) treated with different therapeutic regimens. We enrolled 86 patients aged 18-60 years with an unexplained ischaemic stroke or TIA referred to our inpatient department in the period May 1994-December 1999. Follow-up lasted until April 2003. Patients were excluded if the stroke or TIA was related to large-artery atherosclerosis, small artery occlusion, major cardiac sources of embolism or other uncommon causes. During a follow-up (mean±SD) of 64.1±28.8 months (range 8.1-105.6) a recurrent ischaemic cerebrovascular event occurred in 11/86 patients (12.8%) (5 TIA and 6 strokes). Eight events (4 TIA, 4 strokes) occurred in the 59 patients with PFO alone, three (1 TIA, 2 strokes) in the 21 with PFO plus ASA and none in the 6 patients with ASA alone. In the overall population the cumulative risk of recurrent stroke/TIA was 1.2% at 2 years, 5.5% at 4 years, 7.6% at 6 years and 23.6% at 8 years, and was similar in patients with PFO alone vs. patients with PFO plus ASA (9.0% vs. 6.1% at 6 years, 26.0% vs. 23.1% at 8 years; p>0.05). Nine cerebral ischaemic events (4 TIA, 5 strokes) occurred in the 48 patients treated with antiplatelet drugs (7 in patients with PFO, 2 in patients with PFO plus ASA), and two (1 TIA, 1 stroke) in the 17 patients treated with oral anticoagulants (1 with PFO, 1 with PFO plus ASA). No events occurred in patients submitted to transcatheteral closure.

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Section: Discussionmentioning

confidence: 99%

Recurrent cerebrovascular ischaemic events in patients with interatrial septal abnormalities: a follow-up study

et al. 2006

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“…With a mean follow-up time of 19 months, we saw 4 neurological events, all in patients Ն45 years old. 12 Devuyst et al 13 11 reported on 63 patients followed up for 2.6 years with 4 recurrent neurological events. Reasons for recurrent ischemic events after either surgical or percutaneous PFO closure remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale

et al. 2002

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for the PFO in Cryptogenic Stroke Study (PICSS) Investigators* Background-Patent foramen ovale (PFO) is associated with stroke, but there are no randomized studies to evaluate the efficacy of antithrombotic therapies. Methods and Results-The PFO in Cryptogenic Stroke Study was a 42-center study that evaluated transesophageal echocardiographic findings in patients randomly assigned to warfarin or aspirin in the Warfarin-Aspirin Recurrent Stroke Study. In this study, 630 stroke patients were enrolled, of whom 312 (49.5%) were randomized to warfarin and 318 (50.5%) to aspirin. Of these, 265 patients experienced cryptogenic stroke and 365 experienced known stroke subtypes. End points were recurrent ischemic stroke or death. PFO was present in 203 patients (33.8%). There was no significant difference in the time to primary end points between those with and those without PFO in the overall population (Pϭ0.84; hazard ratio 0.96; 95% CI 0.62 to 1.48; 2-year event rates 14.8% versus 15.4%) or in the cryptogenic subset (Pϭ0.65; hazard ratio 1.17; 95% CI 0.60 to 2.37; 2-year event rates 14.3% versus 12.7%). There was no significant difference among those with no, small, or large PFO (Pϭ0.41 for small PFO and Pϭ0.16 for large PFO; 2-year event rates for no, small, and large PFO, 15.4%, 18.5%, and 9.5%, respectively). There was no significant difference between patients with isolated PFO and those with PFO in association with atrial septal aneurysm (Pϭ0.84; 2-year event rates 14.5% versus 15.9%). In patients with PFO, there was no significant difference in the time to primary end points between those treated with warfarin and those treated with aspirin (Pϭ0.49; hazard ratio 1.29; 95% CI 0.63 to 2.64; 2-year event rates 16.5% versus 13.2%). Conclusions-On

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“…Long-term follow-up of patients having suffered a stroke by paradoxical embolism and treated by shunt closure is scarce and inconclusive. 27,28 The role of shunts demonstrated only during TCD for clinically manifest paradoxical embolism is unknown and requires further research. Anticoagulation would minimize thrombus formation and thus embolization through cardiac and noncardiac shunts.…”

Section: Discussionmentioning

confidence: 99%

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Silling

Stypmann

et al. 2000

Stroke

109

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Background and Purpose-Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Valsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. Methods-Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mL of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM. Results-In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least 1 TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. Conclusions-TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.

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Prognosis after stroke followed by surgical closure of patent foramen ovale

Cited by 144 publications

References 16 publications

Recurrent cerebrovascular ischaemic events in patients with interatrial septal abnormalities: a follow-up study

Recurrent cerebrovascular ischaemic events in patients with interatrial septal abnormalities: a follow-up study

Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

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