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[Cryptogenic stroke and patent foramen ovale]
S Windecker1, K Nedeltchev, A Wahl
1Inselspital Bern, Universitätsspital, Bern. stephan.windecker@insel.ch
Therapeutische Umschau. Revue Therapeutique
|October 29, 2003
Summary
Cryptogenic stroke, often seen in young patients, is strongly linked to patent foramen ovale (PFO). PFO, especially with an atrial septal aneurysm, increases recurrent stroke risk, prompting research into optimal prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Cryptogenic stroke, stroke of unknown origin, affects a significant patient population, particularly younger individuals.
- A patent foramen ovale (PFO) is consistently associated with cryptogenic stroke, suggesting paradoxical embolism as a primary mechanism.
- The presence of an atrial septal aneurysm alongside PFO in cryptogenic stroke patients significantly elevates the risk of recurrent neurological events.
Purpose of the Study:
- To investigate the association between patent foramen ovale and cryptogenic stroke.
- To evaluate the role of atrial septal aneurysm in increasing recurrent event risk in patients with cryptogenic stroke and PFO.
- To review current therapeutic strategies for secondary prevention in this patient group.
Main Methods:
- Review of numerous case-control studies examining the link between PFO and cryptogenic stroke.
- Analysis of data on the prevalence of atrial septal aneurysm in patients with cryptogenic stroke and PFO.
- Examination of therapeutic measures including medical management and device closure.
Main Results:
- A strong and consistent association exists between cryptogenic stroke and the presence of a PFO.
- Approximately 25% of cryptogenic stroke patients with PFO also have an atrial septal aneurysm, increasing risk.
- Medical treatments (antiplatelets, anticoagulants) and PFO closure are key secondary prevention strategies.
Conclusions:
- Patent foramen ovale is a significant factor in cryptogenic stroke, likely via paradoxical embolism.
- Atrial septal aneurysm further heightens the risk of recurrent events in this population.
- Ongoing randomized clinical trials are crucial to determine the optimal secondary prevention strategy, comparing medical management with PFO closure.