Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Patent foramen ovale and embolic cryptogenic stroke

https://doi.org/10.14412/2074-2711-2019-2-4-11

Full Text:

Abstract

The paper considers the actual problem of cryptogenic stroke and patent foramen ovale (PFO). It highlights the issues of pathogenesis and role of paradoxical embolism in the development of cerebral circulation disorders. The features of clinical manifestations and neuroimaging pattern of stroke in the presence of PFO are described. Ultrasound diagnostic techniques used to verify a cardiac anomaly are characterized. Approaches to establishing a cause-and-effect relationship between the presence of PFO and the development of stroke are presented. The current possibilities of secondary prevention in this category of patients, in particular the results of studies of percutaneous PFO occlusion, are discussed.

About the Authors

A. A. Kulesh
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation

Aleksey Aleksandrovich Kulesh

26, Petropavlovskaya St., Perm 614990



V. V. Shestakov
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation

26, Petropavlovskaya St., Perm 614990



References

1. Nouh A, Hussain M, Mehta T, Yaghi S. Embolic Strokes of Unknown Source and Cryptogenic Stroke: Implications in Clinical Practice. Front Neurol. Front Neurol. 2016 Mar 21;7:37. doi: 10.3389/fneur.2016.00037. eCollection 2016.

2. Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014 Apr;13(4):429-38. doi: 10.1016/S14744422(13)70310-7.

3. Perera KS, Swaminathan B, Veltkamp R, et al. Frequency and features of embolic stroke of undetermined source in young adults. European Stroke Journal. 2018;3(2):110-6.

4. Shamalov NA, Kustova MA. Cryptogenic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2S):42-9. (In Russ.). Doi: 10.14412/2074-2711-2014-2S-42-49

5. Saver JL, Mattle HP, Thaler D. Closure Versus Medical Therapy for Cryptogenic Ischemic Stroke: A Topical Review. Stroke. 2018 Jun;49(6):1541-1548. doi: 10.1161/STROKEAHA.117.018153. Epub 2018 May 14.

6. Sun YP, Homma S. Patent Foramen Ovale and Stroke. Circ J. 2016 Jul 25;80(8):1665-73. doi: 10.1253/circj.CJ-16-0534. Epub 2016 Jun 22.

7. Alsheikh-Ali AA, Thaler DE, Kent DM. Patent foramen ovale in cryptogenic stroke: incidental or pathogenic? Stroke. 2009 Jul;40(7):2349-55. doi: 10.1161/STROKEAHA.109.547828. Epub 2009 May 14.

8. Ryoo S, Chung JW, Lee MJ, et al. An Approach to Working Up Cases of Embolic Stroke of Undetermined Source. J Am Heart Assoc. 2016 Mar 22;5(3):e002975. doi: 10.1161/JAHA.115.002975.

9. Lee PH, Song JK, Kim JS, et al. Cryptogenic stroke and high-risk patent foramen ovale: the defense-pfo trial. J Am Coll Cardiol. 2018 May 22;71(20):2335-2342. doi: 10.1016/j.jacc.2018.02.046. Epub 2018 Mar 12.

10. Mazzucco S, Li L, Binney L, Rothwell PM; Oxford Vascular Study Phenotyped Cohort. Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and nondisabling stroke at older ages: a populationbased study, systematic review, and meta-analysis. Lancet Neurol. 2018 Jul;17(7):609-617. doi: 10.1016/S1474-4422(18)30167-4. Epub 2018 Jun 7.

11. Mojadidi MK, Zaman MO, Elgendy IY, et al. Cryptogenic Stroke and Patent Foramen Ovale. J Am Coll Cardiol. 2018 Mar 6;71(9): 1035-1043. doi: 10.1016/j.jacc.2017.12.059.

12. Wessler BS, Thaler DE, Ruthazer R, et al. Transesophageal echocardiography in cryptogenic stroke and patent foramen ovale analysis of putative high-risk features from the risk of paradoxical embolism database. Circ Cardiovasc Imaging. 2014 Jan;7(1):125-31. doi: 10.1161/CIRCIMAGING.113.000807. Epub 2013 Nov 8.

13. Pizova NV. Heart diseases and strokes in young people. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2): 62-9. (In Russ.). doi: 10.14412/2074-27112014-2-62-69

14. Bayar N, Arslan S, Cagirci G, et al. Assessment of morphology of patent foramen ovale with transesophageal echocardiography in symptomatic and asymptomatic patients. J Stroke Cerebrovasc Dis. 2015 Jun;24(6):1282-6. doi: 10.1016/j.jstrokecerebrovasdis.2015.01.036. Epub 2015 Apr 20.

15. Ozdemir AO, Tamayo A, Munoz C, et al. Cryptogenic stroke and patent foramen ovale: clinical clues to paradoxical embolism. J Neurol Sci. 2008 Dec 15;275(1-2):121-7. doi: 10.1016/j.jns.2008.08.018. Epub 2008 Sep 26.

16. Cramer SC, Rordorf G, Maki JH, et al. Increased pelvic vein thrombi in cryptogenic stroke: Results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study. Stroke. 2004 Jan;35(1):46-50. Epub 2003 Dec 4.

17. Liberman AL, Daruwalla VJ, Collins JD, et al. Diagnostic yield of pelvic magnetic resonance venography in patients with cryptogenic stroke and patent foramen ovale. Stroke. 2014 Aug; 45(8):2324-9. doi: 10.1161/STROKEAHA.114.005539. Epub 2014 Jun 17.

18. Osgood M, Budman E, Carandang R, et al. Prevalence of pelvic vein pathology in patients with cryptogenic stroke and patent foramen ovale undergoing MRV pelvis. Cerebrovasc Dis. 2015;39(3-4):216-23. doi: 10.1159/000376613. Epub 2015 Mar 14.

19. Kiernan TJ, Yan BP, Cubeddu RJ, et al. May-Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale: an important clinical association. Stroke. 2009 Apr; 40(4):1502-4. doi: 10.1161/STROKEAHA.108.527366. Epub 2009 Jan 29.

20. West BH, Noureddin N, Mamzhi Y, et al. Frequency of Patent Foramen Ovale and Migraine in Patients With Cryptogenic Stroke. Stroke. 2018 May;49(5):1123-1128. doi: 10.1161/STROKEAHA.117.020160. Epub 2018 Apr 10.

21. Snijder RJ, Luermans JG, de Heij AH, et al. Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study. J Am Heart Assoc. 2016 Dec 1;5(12). pii: e003771.

22. Mojadidi MK, Bokhoor PI, Gevorgyan R, et al. Sleep apnea in patients with and without a right-to-left shunt. J Clin Sleep Med. 2015 Nov 15;11(11):1299-304. doi: 10.5664/jcsm.5190.

23. Thaler DE, Ruthazer R, Di Angelantonio E, et al. Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale. Stroke. 2013 Mar;44(3):675-80. doi: 10.1161/STROKEAHA.112.677039. Epub 2013 Jan 22.

24. Hayashida K, Fukuchi K, Inubushi M, et al. Embolic distribution through patent foramen ovale demonstrated by (99m) Tc-MAA brain SPECT after Valsalva radionuclide venography. J Nucl Med. 2001 Jun;42(6):859-63.

25. Kim BJ, Sohn H, Sun BJ, et al. Imaging characteristics of ischemic strokes related to patent foramen ovale. Stroke. 2013 Dec;44(12): 3350-6. doi: 10.1161/STROKEAHA.113.002459. Epub 2013 Sep 26.

26. Bang OY, Lee MJ, Ryoo S, et al. Patent Foramen Ovale and Stroke-Current Status. J Stroke. 2015 Sep;17(3):229-37. doi: 10.5853/jos.2015.17.3.229. Epub 2015 Sep 30.

27. Akhondi A, Gevorgyan R, Tseng CH, et al. The association of patent foramen ovale morphology and stroke size in patients with paradoxical embolism. Circ Cardiovasc Interv. 2010 Oct;3(5):506-10. doi: 10.1161/CIRCINTERVENTIONS.109.908533. Epub 2010 Sep 21.

28. Kim JW, Kim SJ, Yoon CW, et al. Association between the amount of right-to-left shunt and infarct patterns in patients with cryptogenic embolic stroke: a transcranial Doppler study. Int J Stroke. 2013 Dec;8(8):657-62. doi: 10.1111/j.1747-4949.2012.00846.x. Epub 2012 Jul 19.

29. Liu JR, Plц tz BM, Rohr A, et al. Association of right to-left shunt with frontal white matter lesions in T2-weighted MR imaging of stroke patients. Neuroradiology. 2009 May;51(5):299-304. doi: 10.1007/s00234-0090496-9. Epub 2009 Jan 23.

30. Di Tullio MR, Jin Z, Russo C, et al. Patent foramen ovale, subclinical cerebrovascular disease, and ischemic stroke in a population-based cohort. J Am Coll Cardiol. 2013 Jul 2;62(1): 35-41. doi: 10.1016/j.jacc.2013.03.064. Epub 2013 May 1.

31. Kim SJ, Shin HY, Ha YS, et al. Paradoxical embolism as a cause of silent brain infarctions in healthy subjects: the ICONS study (Identification of the Cause of Silent Cerebral Infarction in Healthy Subjects). Eur J Neurol. 2013 Feb;20(2):353-60. doi: 10.1111/j.14681331.2012.03864.x. Epub 2012 Sep 9.

32. Silvestry FE, Cohen MS, Armsby LB, et al. American Society of Echocardiography; Society for Cardiac Angiography and Interventions. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr. 2015 Aug;28(8):910-58. doi: 10.1016/j.echo.2015.05.015.

33. Mahmoud AN, Elgendy IY, Agarwal N, et al. Identification and quantification of patent foramen ovale mediated shunts: echocardiography and transcranial Doppler. Interv Cardiol Clin. 2017 Oct;6(4):495-504. doi: 10.1016/j.iccl.2017.05.002. Epub 2017 Jun 27.

34. Johansson MC, Helgason H, Dellborg M, Eriksson P. Sensitivity for detection of patent foramen ovale increased with increasing number of contrast injections: A descriptive study with contrast transesophageal echocardiography. J Am Soc Echocardiogr. 2008 May;21(5):419-24. Epub 2007 Oct 10.

35. Schneider B, Zienkiewicz T, Jansen V, et al. Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings. Am J Cardiol. 1996 Jun 1;77(14):1202-9.

36. Katsanos AH, Psaltopoulou T, Sergentanis TN, et al. Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: A systematic review and diagnostic test accuracy meta-analysis. Ann Neurol. 2016 Apr;79(4):625-35. doi: 10.1002/ana.24609. Epub 2016 Mar 11.

37. Droste DW, Lakemeier S, Wichter T, et al. Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Stroke. 2002 Sep;33(9): 2211-6.

38. Mojadidi MK, Roberts SC, Winoker JS, et al. Accuracy of transcranial Doppler for the diagnosis of intracardiac right-to left shunt: a bivariate meta-analysis of prospective studies. Review. JACC Cardiovasc Imaging. 2014 Mar;7(3): 236-50. doi: 10.1016/j.jcmg.2013.12.011. Epub 2014 Feb 19.

39. Serena J, Segura T, Perez-Ayuso MJ, et al. The need to quantify right-to-left shunt in acute ischemic stroke: A case-control study. Stroke. 1998 Jul;29(7):1322-8.

40. Mojadidi MK, Gevorgyan R, Tobis JM. A comparison of methods to detect and quantitate PFO: TCD, TTE, ICE and TEE. In: Amin Z, Tobis J, Sievert H, Carroll J, editors. Patent Foramen Ovale. London: Springer; 2015. P. 55-65.

41. Meissner I, Khandheria BK, Heit JA, et al. Patent foramen ovale: Innocent or guilty?: Evidence from a prospective population-based study. J Am Coll Cardiol. 2006 Jan 17;47(2): 440-5. Epub 2005 Dec 6.

42. Lopez MF, Krastins B, Sarracino DA, et al. Proteomic signatures of serum albumin-bound proteins from stroke patients with and without endovascular closure of PFO are significantly different and suggest a novel mechanism for cholesterol efflux. Clin Proteomics. 2015 Jan 13; 12(1):2. doi: 10.1186/1559-0275-12-2. eCollection 2015.

43. Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013 Aug 13;81(7):619-25. doi: 10.1212/WNL.0b013e3182a08d59. Epub 2013 Jul 17.

44. Thijs VN, Brachmann J, Morillo CA, et al. Predictors for atrial fibrillation detection after cryptogenic stroke: results from CRYSTAL AF. Neurology. 2016 Jan 19;86(3):261-9. doi: 10.1212/WNL.0000000000002282. Epub 2015 Dec 18.

45. Saver JL. Cryptogenic stroke. N Engl J Med. 2016 May 26;374(21):2065-74. doi: 10.1056/NEJMcp1503946.

46. Lapergue B, Decroix JP, Evrard S, et al. Diagnostic yield of venous thrombosis and pulmonary embolism by combined CT venography and pulmonary angiography in patients with cryptogenic stroke and patent foramen ovale. Eur Neurol. 2015;74(1-2):69-72. doi: 10.1159/000437261. Epub 2015 Jul 25.

47. Kobayashi N, Karino T. Flow behavior and distribution of embolus-model particles at the terminal bifurcation of the human internal carotid artery. World Neurosurg. 2016 Jun;90: 469-477. doi: 10.1016/j.wneu.2016.03.012. Epub 2016 Mar 14.

48. Kulesh AA, Golosova YuA, Syromyatnikova LI, Shestakov VV. Additional clinical and instrumental laboratory markers of the main pathogenetic variants of ischemic stroke. Klinicheskaya meditsina. 2018; 96(3):240-7. (In Russ.).

49. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Jul;45(7): 2160-236. doi: 10.1161/STR.0000000000000024. Epub 2014 May 1.

50. Parfenov VA, Verbitskaya SV. Secondary prevention of ischemic stroke: international recommendations and clinical practice. Nevrologicheskii zhurnal. 2014;19(2):4-10. (In Russ.).

51. Parfenov VA, Verbitskaya SV. Secondary prevention of stroke in atrial fibrillation, use of apixaban: ARISTOTLE, AVERROES studies. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2S):7-14. (In Russ.). doi: 10.14412/2074-2711-2014-2S-7-14

52. Parfenov VA, Verbitskaya SV. The risk factors and prevention of stroke in atrial fibrillation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;6(3):55-60. (In Russ.). doi: 10.14412/2074-2711-2014-3-55-60

53. Mas JL, Derumeaux G, Guillon B, et al; CLOSE Investigators. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017 Sep 14;377(11): 1011-1021. doi: 10.1056/NEJMoa1705915.

54. Homma S, Sacco RL, Di Tullio MR, et al. PFO in Cryptogenic Stroke Study (PICSS) Investigators. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002 Jun 4;105(22):2625-31.

55. Kent DM, Dahabreh IJ, Ruthazer R, et al. Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: an individual participant data meta analysis. Eur Heart J. 2015 Sep 14;36(35): 2381-9. doi: 10.1093/eurheartj/ehv252. Epub 2015 Jul 3.

56. Parfenov VA. Prevention of venous thromboembolic events in ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;5(3):49-54. (In Russ.). doi: 10.14412/2074-2711-2013-2341

57. Hornung M, Bertog SC, Franke J, et al. Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale. Eur Heart J. 2013 Nov;34(43):3362-9. doi: 10.1093/eurheartj/eht283. Epub 2013 Jul 9.

58. S∅ndergaard L, Kasner SE, Rhodes JF, et al; Gore REDUCE Clinical Study Investigators. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017 Sep 14;377(11):1033-1042. doi: 10.1056/NEJMoa1707404.

59. Carroll JD, Saver JL, Thaler DE, et al; RESPECT Investigators. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. RESPECT Investigators. N Engl J Med. 2013 Mar 21;368(12):1092-100. doi: 10.1056/NEJMoa1301440.

60. Sitwala P, Khalid MF, Khattak F, et al. Percutaneous closure of patent foramen ovale in patients with cryptogenic stroke – An updated comprehensive meta-analysis. Cardiovasc Revasc Med. 2018 Sep 19. pii: S1553-8389(18)30412-3. doi: 10.1016/j.carrev.2018.09.010. [Epub ahead of print]


For citation:


Kulesh A.A., Shestakov V.V. Patent foramen ovale and embolic cryptogenic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):4-11. (In Russ.) https://doi.org/10.14412/2074-2711-2019-2-4-11

Views: 167


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)