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Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources?
Alessandro Stecco1, Martina Quagliozzi2, Eleonora Soligo2
1Neuroradiology Unit, Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy. a.stecco@libero.it.
Insights
Patent foramen ovale (PFO)-related strokes often involve the vertebro-basilar territory or multiple sites, differing from atrial fibrillation (AF)-related strokes. These PFO-related strokes are frequently cortical in younger patients.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Idiopathic ischemic stroke remains a significant clinical challenge.
- Distinguishing stroke etiology is crucial for effective treatment and prevention.
- Patent foramen ovale (PFO) and atrial fibrillation (AF) are common causes of cardioembolic stroke.
Purpose of the Study:
- To map and compare the specific ischemic lesion patterns in PFO-related stroke (PFO-stroke) versus AF-related stroke (AF-stroke).
- To identify radiological differences that may aid in diagnosing the cause of idiopathic ischemic stroke.
Main Methods:
- Retrospective analysis of 750 ischemic strokes, excluding those with known causes.
- Selection of 171 patients with idiopathic ischemic stroke, divided into AF-stroke (43) and PFO-stroke (128) groups.
- Classification of infarcts based on vascular territories: anterior cerebral artery, middle cerebral artery, vertebro-cerebral artery (VB), and multisite (MS).
Main Results:
- Infarcts in the vertebro-basilar (VB) territory and multisite (MS) patterns were more frequent in the PFO-stroke group (approx. 32% each) compared to the AF-stroke group (p=0.03).
- Ischemic lesions in the PFO-stroke group were predominantly cortical (34.3%), while in the AF-stroke group, they were cortical-subcortical (60.4%).
- A multisite pattern of ischemic lesions was more common in patients with severe right-to-left shunts (37.5%).
Conclusions:
- Patent foramen ovale (PFO) should be considered a potential cause of cortical stroke, particularly in younger patients (<50 years), when radiological findings show vertebro-basilar territory or multisite brain involvement.
- Distinct lesion patterns may help differentiate PFO-related strokes from AF-related strokes.
- Radiological mapping of infarct distribution is valuable in the etiological diagnosis of cryptogenic stroke.
Purpose:
The aim of this retrospective study was to map the specific ischemic lesion patterns of distribution in patent foramen ovale-related stroke (PFO-stroke) and atrial fibrillation-related stroke (AF-stroke) in patients with idiopatic ischemic stroke.
Materials And Methods:
750 ischaemic strokes were screened on basis of diagnostic imaging and tests: patients with known causes were excluded. 171 patients with unknown cause were selected and divided in two groups: AF-stroke (43 patients) and PFO-stroke (128 patients). Vascular territories of ischemic involvement were divided into four classes in each group: the anterior cerebral artery, the middle cerebral artery, the vertebro-cerebral artery (including the posterior cerebral artery) and multisite (MS) involvement.
Results:
Infarcts in vertebro-basilar territory and multisite represented each one about 32% of infarcts in PFO-stroke group and their involvement are more frequent than AF-stroke group (p = 0.03). Ischemic lesions in PFO-group were predominantly cortical (34.3%), and in AF-group cortical-subcortical (60.4%). Multisite pattern of ischemic lesion was more frequent in patients with severe degree of right to left shunts (37.5%).
Conclusion:
In clinical practice, PFO may be considered a cause of cortical stroke on the basis of radiological findings, when VB vascular territory or MS brain involvement is present in younger patients (<50 age).
