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Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke
M M Steiner1, M R Di Tullio, T Rundek
1Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Background And Purpose:
Although the cause of stroke among patients with patent foramen ovale (PFO) may be due to paradoxical cerebral embolism (PCE), this mechanism is often difficult to prove. The aim of our study was to evaluate the association between brain imaging findings suggestive of embolism and PFO among ischemic stroke patients.
Methods:
As part of the Northern Manhattan Stroke Study, 95 patients with first ischemic stroke over age 39 underwent transesophageal echocardiography (TEE) for evaluation of a cardiac source of embolism. The stroke subtype was determined by modified NINDS Stroke Data Bank criteria. Stroke subtype and MRI/CT imaging data were evaluated blind to the presence of a PFO. These findings were compared between two groups: patients with medium to large PFO (> or =2 mm) and small (<2 mm) or no PFO.
Results:
Of the 95 patients who underwent TEE, 31 (33%) had a PFO. The frequency of PFO was significantly greater among patients with cryptogenic infarcts (19 of 42; 45%) compared with patients with determined cause of stroke (12 of 53, 23%; P=0.02). Medium to large PFOs were found more often among cryptogenic strokes than among infarcts of determined cause (26% versus 6%; P=0.04). Superficial infarcts occurred more often in the group with larger PFOs than in the group with small or no PFOs (50% versus 21%; P=0.02). Patients with medium or large PFOs more frequently had occipital and infratentorial strokes (57% versus 27%; P=0.02).
Conclusions:
Stroke patients with larger PFOs show more brain imaging features of embolic infarcts than those with small PFOs. Larger PFOs may be more likely to cause paradoxical embolization and may help explain the stroke mechanism among patients with no other definite cause.
Insights
Larger patent foramen ovale (PFO) in stroke patients are linked to more brain imaging signs of embolism. This suggests PFO may be a key cause of paradoxical cerebral embolism in cryptogenic strokes.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Patent foramen ovale (PFO) is a potential cause of ischemic stroke, often via paradoxical cerebral embolism (PCE).
- Diagnosing PCE as the stroke mechanism in PFO patients is challenging.
- This study investigates the association between PFO size and brain imaging indicators of embolism.
Purpose of the Study:
- To evaluate the relationship between brain imaging findings suggestive of embolism.
- To determine the association with patent foramen ovale (PFO) in ischemic stroke patients.
Main Methods:
- Transesophageal echocardiography (TEE) was used to detect PFO in 95 ischemic stroke patients.
- Stroke subtypes were classified using modified NINDS criteria.
- Brain imaging (MRI/CT) was reviewed blindly for embolic findings, comparing patients with medium-to-large PFOs versus small/no PFOs.
Main Results:
- 33% of patients had a PFO; larger PFOs were more frequent in cryptogenic strokes (26% vs. 6%).
- Superficial infarcts (50% vs. 21%) and occipital/infratentorial strokes (57% vs. 27%) were more common with larger PFOs.
- PFO presence was significantly higher in cryptogenic strokes (45%) compared to determined strokes (23%).
Conclusions:
- Larger PFOs correlate with increased brain imaging evidence of embolic infarcts.
- This suggests larger PFOs are more likely to cause PCE.
- PFO size may help elucidate stroke mechanisms in patients without other identified causes.