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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Prevalence of Patent Foramen Ovale in North Indian Cryptogenic Young Strokes
Dheeraj Khurana1, Gayathri Petluri1, Mukesh Kumar1
1Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Patent foramen ovale (PFO) causes right-to-left shunts (RLS) in young cryptogenic stroke (CS) patients in North India. Transcranial Doppler (TCD) with bubble contrast effectively detects RLS, aiding diagnosis.
Area of Science:
- Neurology
- Cardiology
- Diagnostic Imaging
Background:
- Cryptogenic strokes (CS) constitute 30-40% of ischemic strokes.
- Patent foramen ovale (PFO) is a potential cause of CS through paradoxical embolism.
- Data on PFO prevalence in Indian CS patients are scarce.
Purpose of the Study:
- To determine the prevalence of right-to-left shunt (RLS) secondary to PFO in young North Indian CS patients.
- To evaluate Transcranial Doppler (TCD) with bubble contrast as a diagnostic tool for RLS in this population.
Main Methods:
- A hospital-based prospective cross-sectional study involving 57 young CS patients (15-45 years) and 50 healthy controls.
- Transcranial Doppler (TCD) with bubble contrast was used to detect RLS.
- Risk of Paradoxical Embolism (RoPE) score was calculated for patients.
Main Results:
- RLS was detected in 31% of CS patients versus 6% of controls (P = 0.001).
- All TCD-positive RLS patients had superficial cortical infarcts (P = 0.03).
- The median RoPE score in CS patients was 9 (range: 7-10).
Conclusions:
- A high prevalence of RLS, likely due to PFO, exists in young cryptogenic stroke patients in North India.
- TCD with bubble contrast is a highly effective bedside tool for diagnosing RLS.
Background:
: Strokes of the undetermined cause or cryptogenic strokes (CS) account for 30-40% of ischemic strokes. Paradoxical embolism secondary to patent foramen ovale (PFO) may be associated with CS. Transcranial Doppler (TCD) with bubble contrast is a noninvasive bedside tool for diagnosis of right-to-left shunt (RLS) with high sensitivity and specificity. Data on the prevalence of PFO in CS in India are lacking. We determined the prevalence of RLS likely secondary to PFO in cryptogenic young strokes of the north Indian population using TCD with bubble contrast.
Patients And Methods:
: In this hospital-based prospective cross-sectional study, TCD with bubble contrast was performed in 57 young (age 15 > 45 years) CS and 50 healthy controls for the detection of RLS. The risk of paradoxical embolism (RoPE) score was calculated from various variables such as age, presence of cortical stroke on neuroimaging, and absence of vascular risk factors.
Results:
: 57 young CS and 50 healthy controls were recruited. TCD with bubble contrast was positive in 31% cases vs 6% in controls (P = 0.001). All patients with TCD positive for RLS had superficial cortical infarcts (P = 0.03). The median RoPE score of our patients was 9 (range: 7-10).
Conclusions:
: There is a high prevalence of RLS likely secondary to PFO in cryptogenic young strokes in north India. TCD with bubble contrast is an excellent bedside tool for the detection of RLS.
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