The Role of Patent Foramen Ovale in Cryptogenic Stroke (original) (raw)
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Circulation. Cardiovascular interventions, 2010
Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke through paradoxical embolization to the cerebral circulation. This study evaluated the relationship between the morphological and functional size of the PFO by echocardiography compared with cerebral infarct volume identified on MRI. Patients who were referred to interventional cardiology with the diagnosis of cryptogenic stroke were included and had either a transesophageal echocardiogram or an intracardiac echo and a brain MRI at the time of stroke. Transesophageal echocardiogram or intracardiac echo was used to obtain PFO measurements. MRI of the brain with 3 sequences (T2, diffusion-weighted imaging, and fluid-attenuated inversion recovery) was used to diagnose acute stroke and measure the infarct volume. In the 72 patients studied, the median measured stroke volume was 4.3 cm(3) on diffusion-weighted imaging, 4.1 cm(3) on T2, and 3.5 cm(3) on fluid-attenuated inversion recovery. There was n...
Patent Foramen Ovale: Paradoxical Embolism and Paradoxical Data
Mayo Clinic Proceedings, 2004
related to the diagnosis and treatment of patients with cerebral infarction and PFO. These articles are timely because of the considerable interest, within the cardiology community, in the importance of PFO. Some cardiologists estimate that 60,000 to 110,000 strokes are secondary to paradoxical embolism via a PFO. 16,17 Besides preventing stroke, transcatheter closure of PFO has been proposed as a prophylactic treatment for migraine headache. 18 However, questions persist. Much of the current evidence is circumstantial or anecdotal. Reports about the potential utility of medical or surgical interventions are from uncontrolled studies, which can be biased. When the rules of evidence are used, these studies provide data of modest strength. Of note, evidence from prospective clinical studies has not matched our preconceived notions. 19,20 Specifically, the risk of stroke might not be as high as previously believed, and relatively conservative medical therapies might be effective. Because of reservations about the robustness of the current data, many neurologists are uncertain about the cause-and-effect relationship between PFO and stroke and about the best management of patients. See also pages 24, 35, and 79. This commentary poses a series of questions and includes currently available data; it also serves as a springboard for further discussions. What Is the Association Between PFO and Cerebral Infarction? 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% to 25%. 16,21,22 On the basis of this prevalence, we can estimate that approximately 60 million to 70 million Americans have a PFO. Thus, detection of a PFO during the evaluation of a patient with stroke is not surprising, and the frequency
Patent Foramen Ovale and Cryptogenic Stroke: Challenges in Diagnosis and Management
Indonesian Journal of Cardiology
A patent foramen ovale (PFO) is a common disorder that affects between 20-34% of the adult population. This condition is a benign finding for most people. However, In some the PFO can open widely and enabling paradoxical embolism to transit from venous to arterial circulation, which is associated with stroke and systemic embolization. There are still unclear to date regarding the effectiveness of pharmacological anticoagulant therapy, defined as antithrombin or antiplatelet therapy, which has proven to be more beneficial for patients with PFO and cryptogenic stroke. In addition, surgical and transcutaneous PFO closure has been proposed for secondary prevention of stroke in patients with cryptogenic stroke with PFO. Both catheter-based and surgical modes of closure have been shown to reduce the incidence of subsequent embolism substantially. This review will discuss the evidence regarding the relationship between PFO and cryptogenic stroke and decision making for management strategies.