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Patent foramen ovale-related stroke: diagnostic approaches and the possibility of endovascular prophylaxis (clinical cases and literature review)

https://doi.org/10.14412/2074-2711-2020-2-72-78

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Abstract

The paper describes three clinical cases of ischemic stroke (IS) in the presence of patent foramen ovale (PFO) in young women. The first patient has experienced two episodes of focal neurological deficit related to physical exercise. A cerebellar stroke focus was visualized by brain magnetic resonance imaging (MRI). During emotional stress, the second patient having migraine with aura developed transient weakness in the right extremities, and a stroke focus was verified in the left parietal lobe. The third patient suddenly had facial asymmetry and left arm numbness after  awakening in the morning. The patient underwent intravenous thrombolysis; control brain MRI revealed a right parietal lobe stroke. Standard examinations of all the patients established no cause of IS. Transcranial Doppler with a bubble test and subsequent transesophageal echocardiography revealed PFO that was regarded as clinically significant. Endovascular occlusion was successfully accomplished in all the patients. The paper discusses the problems of secondary prevention of PFO-related stroke and proposes an algorithm for the diagnosis and treatment of this disease.

About the Authors

A. A. Kulesh
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
2, Kim St., Perm 614107, Russia

26, Petropavlovskaya St., Perm 614990



D. V. Ognerubov
National Medical Research Center of Cardiology, Ministry of Health of Russia
Russian Federation
15a, Third Cherepkovskaya St., Moscow 121552, Russia



S. A. Mekhryakov
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
2, Kim St., Perm 614107, Russia 

26, Petropavlovskaya St., Perm 614990 


E. V. Merkulov
National Medical Research Center of Cardiology, Ministry of Health of Russia
Russian Federation
15a, Third Cherepkovskaya St., Moscow 121552, Russia



L. I. Syromyatnikova
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
2, Kim St., Perm 614107, Russia 

26, Petropavlovskaya St., Perm 614990 


A. S. Tereshchenko
National Medical Research Center of Cardiology, Ministry of Health of Russia
Russian Federation
15a, Third Cherepkovskaya St., Moscow 121552, Russia



A. N. Samko
National Medical Research Center of Cardiology, Ministry of Health of Russia
Russian Federation
15a, Third Cherepkovskaya St., Moscow 121552, Russia



V. V. Shestakov
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
2, Kim St., Perm 614107, Russia



Yu. V. Karakulova
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
2, Kim St., Perm 614107, Russia



References

1. Giblett J, Abdul-Samad O, Shapiro L, et al. Patent Foramen Ovale Closure in 2019. Interv Cardiol. 2019 Feb;14(1):34-41. doi: 10.15420/icr.2018.33.2.

2. Kulesh AA, Shestakov VV. Patent foramen ovale and embolic cryptogenic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):4-11. (In Russ.). doi: 10.14412/2074-2711-2019-2-4-11

3. 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.

4. 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.

5. Nam KW, Guk HS, Kwon HM, Lee YS. Diffusion-Weighted Imaging Patterns According to the Right-to-Left Shunt Amount in Cryptogenic Stroke. Cerebrovasc Dis. 2019;48(1-2):45-52. doi: 10.1159/000502882. Epub 2019 Sep 6.

6. Pristipino C, Sievert H, D'Ascenzo F, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EuroIntervention. 2019 Jan 20;14(13): 1389-1402. doi: 10.4244/EIJ-D-18-00622.

7. Kulesh AA, Drobakha VE, Shestakov VV. Cryptogenic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4): 14-21. (In Russ.). doi: 10.14412/2074-2711-2019-4-14-21

8. Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988 May 5;318(18): 1148-52.

9. Webster MW, Chancellor AM, Smith HJ, et al. Patent foramen ovale in young stroke patients. Lancet. 1988 Jul 2;2(8601):11-2.

10. Homma S, Sacco RL. Patent foramen ovale and stroke. Circulation. 2005 Aug 16; 112(7):1063-72.

11. Di Tullio MR, Sacco RL, Sciacca RR, et al. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J Am Coll Cardiol. 2007 Feb 20;49(7):797-802. Epub 2007 Feb 5.

12. Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012 Mar 15;366(11):991-9. doi: 10.1056/NEJMoa1009639.

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

14. Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013 Mar 21;368(12):1083-91. doi: 10.1056/NEJMoa1211716.

15. 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.

16. 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.

17. 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.

18. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology and management of ischaemic stroke in young adults. Lancet Neurol. 2018 Sep;17(9):790-801. doi: 10.1016/S1474-4422(18)30233-3.

19. Singhal AB, Biller J, Elkind MS, et al. Recognition and management of stroke in young adults and adolescents. Neurology. 2013 Sep 17;81(12):1089-97. doi: 10.1212/WNL.0b013e3182a4a451. Epub 2013 Aug 14.

20. Quenardelle V, Lauer-Ober V, Zinchenko I, et al. Stroke Mimics in a Stroke Care Pathway Based on MRI Screening. Cerebrovasc Dis. 2016;42(3-4):205-12. doi: 10.1159/000445956. Epub 2016 Apr 26.

21. Kalashnikova LA, Dobrynina LA. Ischemic stroke at a young age. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(8): 3-12. (In Russ.).

22. 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.

23. 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.

24. 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.

25. Kalashnikova LA. Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;5(2S): 40-5. (In Russ.). doi: 10.14412/2074-2711-2013-2357

26. 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.

27. 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.

28. 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.

29. Nakayama R, Takaya Y, Akagi T, et al. Identification of High-Risk Patent Foramen Ovale Associated With Cryptogenic Stroke: Development of a Scoring System. J Am Soc Echocardiogr. 2019 Jul;32(7):811-816. doi: 10.1016/j.echo.2019.03.021. Epub 2019 May 23.

30. Wintzer-Wehekind J, Alperi A, Houde C, et al. Impact of Discontinuation of Antithrombotic Therapy Following Closure of Patent Foramen Ovale in Patients With Cryptogenic Embolism. Am J Cardiol. 2019 May 1;123(9):1538-1545. doi: 10.1016/j.amjcard.2019.01.043. Epub 2019 Feb 8.

31. Wintzer-Wehekind J, Alperi A, Houde C et al. Long-Term Follow-Up After Closure of Patent Foramen Ovale in Patients With Cryptogenic Embolism. J Am Coll Cardiol. 2019 Jan 29;73(3):278-287. doi: 10.1016/j.jacc.2018.10.061.

32. Hviid CVB, Simonsen CZ, Hvas AM. Recurrence Risk in Patients with Cryptogenic Stroke, Patent Foramen Ovale, and Thrombophilia: A Systematic Review and Meta-Analysis. Thromb Haemost. 2019 Nov; 119(11):1839-1848. doi: 10.1055/s-0039-1693739. Epub 2019 Aug 4.


For citation:


Kulesh A.A., Ognerubov D.V., Mekhryakov S.A., Merkulov E.V., Syromyatnikova L.I., Tereshchenko A.S., Samko A.N., Shestakov V.V., Karakulova Y.V. Patent foramen ovale-related stroke: diagnostic approaches and the possibility of endovascular prophylaxis (clinical cases and literature review). Neurology, Neuropsychiatry, Psychosomatics. 2020;12(2):72-78. (In Russ.) https://doi.org/10.14412/2074-2711-2020-2-72-78

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