Patent foramen ovale and stroke: Difference between revisions
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==[[Patent foramen ovale]] and recurrent [[stroke]]== | ==[[Patent foramen ovale]] and recurrent [[stroke]]== | ||
There exists a discrepancy between influence of [[patent foramen ovale]] ([[PFO]]) on recurrent [[stroke]] (after first episode of [[Paradoxical embolism|cryptogenic stroke]]). Several factors have been found associated with a [[patent foramen ovale]] ([[PFO]]) that might increase the incidence of recurrent [[strokes]] namely, [[atrial septal aneurysm]] <ref name="pmid11742048">{{cite journal| author=Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G et al.| title=Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 24 | pages= 1740-6 | pmid=11742048 | doi=10.1056/NEJMoa011503 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11742048 }} </ref>, (ASA) in association with [[PFO]], bigger shunts, longer tunnels <ref name="pmid19101242">{{cite journal| author=Goel SS, Tuzcu EM, Shishehbor MH, de Oliveira EI, Borek PP, Krasuski RA et al.| title=Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients. | journal=Am J Cardiol | year= 2009 | volume= 103 | issue= 1 | pages= 124-9 | pmid=19101242 | doi=10.1016/j.amjcard.2008.08.036 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19101242 }} </ref>. Nevertheless, some studies have found no association between [[PFO]] or abnormal septal morphology with recurrent [[strokes]] <ref name="pmid18818401">{{cite journal| author=Serena J, Marti-Fàbregas J, Santamarina E, Rodríguez JJ, Perez-Ayuso MJ, Masjuan J et al.| title=Recurrent stroke and massive right-to-left shunt: results from the prospective Spanish multicenter (CODICIA) study. | journal=Stroke | year= 2008 | volume= 39 | issue= 12 | pages= 3131-6 | pmid=18818401 | doi=10.1161/STROKEAHA.108.521427 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18818401 }} </ref>. | * There exists a discrepancy between influence of [[patent foramen ovale]] ([[PFO]]) on recurrent [[stroke]] (after first episode of [[Paradoxical embolism|cryptogenic stroke]]). | ||
* Several factors have been found associated with a [[patent foramen ovale]] ([[PFO]]) that might increase the incidence of recurrent [[strokes]] namely, [[atrial septal aneurysm]] <ref name="pmid11742048">{{cite journal| author=Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G et al.| title=Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 24 | pages= 1740-6 | pmid=11742048 | doi=10.1056/NEJMoa011503 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11742048 }} </ref>, (ASA) in association with [[PFO]], bigger shunts, longer tunnels <ref name="pmid19101242">{{cite journal| author=Goel SS, Tuzcu EM, Shishehbor MH, de Oliveira EI, Borek PP, Krasuski RA et al.| title=Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients. | journal=Am J Cardiol | year= 2009 | volume= 103 | issue= 1 | pages= 124-9 | pmid=19101242 | doi=10.1016/j.amjcard.2008.08.036 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19101242 }} </ref>. | |||
* Nevertheless, some studies have found no association between [[PFO]] or abnormal septal morphology with recurrent [[strokes]] <ref name="pmid18818401">{{cite journal| author=Serena J, Marti-Fàbregas J, Santamarina E, Rodríguez JJ, Perez-Ayuso MJ, Masjuan J et al.| title=Recurrent stroke and massive right-to-left shunt: results from the prospective Spanish multicenter (CODICIA) study. | journal=Stroke | year= 2008 | volume= 39 | issue= 12 | pages= 3131-6 | pmid=18818401 | doi=10.1161/STROKEAHA.108.521427 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18818401 }} </ref>. | |||
* Therefore, studies are not able to establish a clear association of [[patent foramen ovale]] with recurrent [[strokes]]. The reasons for conflicting results could be due to- | |||
** The studies didn’t control the nature of treatment after the index episode of stroke i.e. patients with one episode of cryptogenic stroke were given either medical (antiplatelet), percutaneous closure or no treatment depending on physician’s decision. Thus, a possibility could be that medical treatment might be highly effective and obscures the risk of [[patent foramen ovale]] | |||
==References== | ==References== | ||
Revision as of 15:22, 5 September 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
Association of cryptogenic stroke/transient ischemic attacks with patent foramen ovale
- One in every four cases of ischemic stroke does not have an identifiable cause other than cryptogenic stroke which is a diagnosis of exclusion[1].
- Cryptogenic stroke occurs more commonly in younger patients.
- The association between the presence of a patent foramen ovale and cryptogenic stroke is controversial and inconsistent. While some studies have demonstrated an increased incidence of patent foramen ovale (PFO) in younger patients with cryptogenic stroke [2] others failed to show an association [3].
Patent foramen ovale and first stroke
Although, two prospective cohort studies namely, ‘ The Northern Manhattan Study’ (NOMAS) [4] and 'Stroke Prevention: Assessment of Risk in a Community' (SPARC) [5], found an increased incidence of first stroke in patients with patent foramen ovale, both these studies did not reach a statistical significance.
Patent foramen ovale and recurrent stroke
- There exists a discrepancy between influence of patent foramen ovale (PFO) on recurrent stroke (after first episode of cryptogenic stroke).
- Several factors have been found associated with a patent foramen ovale (PFO) that might increase the incidence of recurrent strokes namely, atrial septal aneurysm [6], (ASA) in association with PFO, bigger shunts, longer tunnels [7].
- Nevertheless, some studies have found no association between PFO or abnormal septal morphology with recurrent strokes [8].
- Therefore, studies are not able to establish a clear association of patent foramen ovale with recurrent strokes. The reasons for conflicting results could be due to-
- The studies didn’t control the nature of treatment after the index episode of stroke i.e. patients with one episode of cryptogenic stroke were given either medical (antiplatelet), percutaneous closure or no treatment depending on physician’s decision. Thus, a possibility could be that medical treatment might be highly effective and obscures the risk of patent foramen ovale
References
- ↑ Sacco RL, Ellenberg JH, Mohr JP, Tatemichi TK, Hier DB, Price TR; et al. (1989). "Infarcts of undetermined cause: the NINCDS Stroke Data Bank". Ann Neurol. 25 (4): 382–90. doi:10.1002/ana.410250410. PMID 2712533.
- ↑ Overell JR, Bone I, Lees KR (2000). "Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies". Neurology. 55 (8): 1172–9. PMID 11071496.
- ↑ Poppert H, Morschhaeuser M, Feurer R, Bockelbrink A, Schwarze J, Esposito L; et al. (2008). "Lack of association between right-to-left shunt and cerebral ischemia after adjustment for gender and age". J Negat Results Biomed. 7: 7. doi:10.1186/1477-5751-7-7. PMC 2577085. PMID 18851751.
- ↑ Di Tullio MR, Sacco RL, Sciacca RR, Jin Z, Homma S (2007). "Patent foramen ovale and the risk of ischemic stroke in a multiethnic population". J Am Coll Cardiol. 49 (7): 797–802. doi:10.1016/j.jacc.2006.08.063. PMID 17306710.
- ↑ Meissner I, Khandheria BK, Heit JA, Petty GW, Sheps SG, Schwartz GL; et al. (2006). "Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study". J Am Coll Cardiol. 47 (2): 440–5. doi:10.1016/j.jacc.2005.10.044. PMID 16412874.
- ↑ Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G; et al. (2001). "Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both". N Engl J Med. 345 (24): 1740–6. doi:10.1056/NEJMoa011503. PMID 11742048.
- ↑ Goel SS, Tuzcu EM, Shishehbor MH, de Oliveira EI, Borek PP, Krasuski RA; et al. (2009). "Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients". Am J Cardiol. 103 (1): 124–9. doi:10.1016/j.amjcard.2008.08.036. PMID 19101242.
- ↑ Serena J, Marti-Fàbregas J, Santamarina E, Rodríguez JJ, Perez-Ayuso MJ, Masjuan J; et al. (2008). "Recurrent stroke and massive right-to-left shunt: results from the prospective Spanish multicenter (CODICIA) study". Stroke. 39 (12): 3131–6. doi:10.1161/STROKEAHA.108.521427. PMID 18818401.