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Prevention of stroke recurrence with presumed paradoxical embolism
J Bogousslavsky1, G Devuyst, M Nendaz
1Department of Neurology, CHUV, Lausanne, Switzerland. Julien.Bogousslavsky@chuv.hospvd.ch
Abstract:
Paradoxical cerebral embolism (PCE) through a patent foramen ovale (PFO) should be considered as a cause of ischemic stroke, particularly in young patients without an alternative cause for stroke. PCE is even more important that it is potentially treatable. However, PCE remains often presumed because it rests upon the rarely demonstrated findings of a deep venous thrombosis and a thrombus lodged in the PFO. Recent studies have shown a rather low stroke recurrence rate in patients with PFO and stroke but suggest that some subgroups of patients with a higher stroke recurrence risk-exist according clinical, echocardiographical and radiological characteristics. For these subgroups, it seems that a more invasive treatment should be required. There are four therapeutic options; antiaggregants, anticoagulation, transcatheter closure of PFO, and surgical closure of PFO. However, these treatments have yet to be evaluated in clinical trials.
Insights
Paradoxical cerebral embolism (PCE) via patent foramen ovale (PFO) is a treatable cause of ischemic stroke, especially in young patients. Identifying high-risk stroke recurrence subgroups may guide more invasive treatment strategies.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Paradoxical cerebral embolism (PCE) through a patent foramen ovale (PFO) is a potential cause of ischemic stroke.
- PCE is particularly relevant in young patients lacking other stroke etiologies and is a potentially treatable condition.
Purpose of the Study:
- To highlight the importance of considering PCE in ischemic stroke evaluations.
- To discuss the diagnostic challenges and therapeutic options for PCE.
- To identify patient subgroups at higher risk for stroke recurrence.
Main Methods:
- Review of existing literature on PCE and PFO.
- Analysis of clinical, echocardiographical, and radiological characteristics associated with stroke recurrence.
- Discussion of current therapeutic strategies including antiplatelets, anticoagulation, and PFO closure (transcatheter and surgical).
Main Results:
- PCE diagnosis is often presumed due to the difficulty in demonstrating deep venous thrombosis and PFO thrombi.
- Recent studies indicate a low stroke recurrence rate in PFO patients, but specific subgroups exhibit higher risks.
- Four therapeutic options exist: antiplatelets, anticoagulation, transcatheter PFO closure, and surgical PFO closure.
Conclusions:
- PCE should be considered in the differential diagnosis of ischemic stroke, especially in younger individuals.
- Further clinical trials are needed to evaluate the efficacy of different therapeutic options for PCE.
- Identifying high-risk subgroups may necessitate more aggressive treatment approaches.