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Patent foramen ovale may be causal for the first stroke but unrelated to subsequent ischemic events
- Source :
- Stroke. 42(10)
- Publication Year :
- 2011
-
Abstract
- Background and Purpose— Studies with very long follow-up are scarce in patients with cryptogenic stroke and patent foramen ovale (PFO). Little is known about the etiology of recurrent cerebrovascular events (CVE) in PFO patients. Methods— We collected information on recurrent CVE in 308 patients with cryptogenic stroke and PFO and sought to determine concurrent stroke causes that had emerged or been newly detected since the index event. One hundred fifty-eight patients received aspirin (48%), clopidogrel (2%), or oral anticoagulants (50%; medical group). One hundred fifty patients underwent percutaneous PFO closure (closure group). Results— Mean age at index event was 50 years (SD 13). In 33% of patients, the index stroke or transient ischemic attack was preceded by at least 1 CVE. Mean follow-up was 8.7±4.0 years. During follow-up, 32 recurrent CVE (13 strokes and 19 transient ischemic attacks) occurred in the medical and 16 recurrent CVE (8 strokes and 8 transient ischemic attacks) in the closure group. Concurrent etiologies were identified for 12 recurrent CVE in the medical group (38%): large artery disease (9%), small artery disease (6%), cardioembolism (13%), cerebral vasculitis (3%), and antiphospholipid-antibody-syndrome (6%). In the closure group, 7 recurrent CVE had a concurrent etiology (44%): large artery disease (6%), small artery disease (19%), cardioembolism (13%), and thrombophilic disorder (6%). The frequency of concurrent etiologies did not differ between patients with recurrent CVE under medical treatment and those undergoing PFO closure ( P =0.68). Conclusions— Concurrent etiologies are identified for more than one third of recurrent ischemic events in patients with cryptogenic stroke, casting doubt on the sole causal role of PFO.
- Subjects :
- Adult
Male
medicine.medical_specialty
Percutaneous
Ticlopidine
Right-to-left shunt
Foramen Ovale, Patent
Brain Ischemia
Recurrence
Internal medicine
medicine.artery
medicine
Humans
Stroke
Foramen ovale (heart)
Aged
Advanced and Specialized Nursing
Aspirin
business.industry
Middle Aged
medicine.disease
Clopidogrel
Surgery
medicine.anatomical_structure
Treatment Outcome
Etiology
Patent foramen ovale
Cardiology
Female
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 15244628
- Volume :
- 42
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....45ef2739afb14ac550185ea5badbdff6