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Secondary stroke prevention: patent foramen ovale, aortic plaque, and carotid stenosis

Bernhard Meier1, Benedikt Frank, Andreas Wahl

  • 1Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital Bern, 3010 Bern, Switzerland. bernhard.meier@insel.ch

European Heart Journal
|March 17, 2012
PubMed

Insights

Patent foramen ovale (PFO) is a potential stroke cause in all ages. While controversial, PFO closure and aortic plaque management are key considerations for stroke prevention strategies.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Vascular Surgery

Background:

  • Stroke is a leading cause of disability, with diverse underlying etiologies.
  • Patent foramen ovale (PFO) is a standard consideration in young stroke patients.
  • Atherosclerosis and atrial fibrillation are primary concerns in elderly stroke patients, but PFO should also be evaluated.

Purpose of the Study:

  • To review the role of PFO and aortic plaques in stroke etiology.
  • To discuss current and potential management strategies for PFO-related stroke and atherosclerosis.
  • To highlight controversies and evidence gaps in PFO closure and plaque management.

Main Methods:

  • Literature review of studies on stroke causes, PFO, and aortic plaques.
  • Analysis of risk factors and treatment options for stroke.
  • Evaluation of evidence for PFO closure and management of atherosclerotic plaques.

Main Results:

  • PFO is a recognized, though debated, cause of stroke, particularly in younger individuals.
  • Proximal aortic plaques are strongly associated with stroke, similar to PFO.
  • Statins can inhibit plaque progression; antiplatelet agents and endarterectomy are primary treatments for atherosclerosis.

Conclusions:

  • PFO and aortic plaques are significant, albeit sometimes overlooked, contributors to stroke.
  • Management strategies for stroke require individualized assessment of PFO, atherosclerosis, and other risk factors.
  • Further research is needed to clarify the long-term risks and optimal prevention for PFO-related strokes.

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