Analysis of Risk Factors Related to the Efficacy of Foramen Ovale Closure as a Therapy for Migraine

2022 ◽  
Author(s):  
Ya-jing Tang ◽  
Hai Liu ◽  
Wei-wei Zhang ◽  
Qi Li ◽  
Tian-hua Xie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Foramen Ovale

Patent Foramen Ovale Channel Morphometric Characteristics as Risk Factors for Cryptogenic Stroke

2020 ◽  
Vol 34 (S1) ◽  
pp. 1-1
Author(s):  
Jakub Piotr Holda ◽  
Kamil Bugala ◽  
Agata Krawczyk-Ozog ◽  
Mateusz Koziej ◽  
Danuta Sorysz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Morphometric Characteristics

scholarly journals Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

2019 ◽  
Vol 11 (1) ◽  
pp. 22-33
Author(s):  
Konark Malhotra ◽  
Aristeidis Katsanos ◽  
Alexandra Frogoudak ◽  
Agathi-Rosa Vrettou ◽  
Ignatios Ikonomidis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transcranial Doppler ◽  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Secondary Stroke Prevention ◽  
Foramen Ovale

scholarly journals Cryptogenic Stroke: A Challenge in Diagnosis and Management

2021 ◽  
Vol 42 (3) ◽  
Author(s):  
Sidhi Laksono Purwowiyoto ◽  
Budhi Setianto ◽  
Gea Panindhita ◽  
Reynaldo Halomoan ◽  
I Nyoman Wiryawan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Stroke Recurrence ◽  
Clinical Settings ◽  
Cardiac Structure ◽  
Foramen Ovale ◽  
Advanced Knowledge ◽  
Pfo Closure

Ischemic stroke is responsible for 85% of all stroke globally. However, the etiology of around a quarter of ischemic stroke are undetermined, this is called cryptogenic stroke. This kind of stroke affects younger population. Several mechanism are associated with the incidence of cryptogenic stroke such as paroxysmal atrial fibrillation, patent foramen ovale, atherosclerosis, and atrial cardiopathy. Despite many advanced knowledge on stroke generally, cryptogenic stroke is still a challenge in clinical settings. To understand more about cryptogenic stroke, a new term of embolic strokes of undetermined source (ESUS) is proposed and may need a specific workup. Specific workup aims to detect any silent risk factors and also to evaluate the cardiac structure. The term of ESUS also leads to the understanding that cryptogenic stroke is highly related to embolic mechanism and anticoagulation administration might benefit the patients. However, the result of several recent studies showed that anticoagulant was not superior to antiplatelet, and antiplatelet is still the preferred treatment. Studies on PFO closure also shows different result, but the majority of the trials showed benefit of PFO closure in reducing the risk of stroke recurrence.

scholarly journals Prevalence of Pelvic Vein Pathology in Patients with Cryptogenic Stroke and Patent Foramen Ovale Undergoing MRV Pelvis

2015 ◽  
Vol 39 (3-4) ◽  
pp. 216-223 ◽  
Author(s):  
Marcey Osgood ◽  
Elizabeth Budman ◽  
Raphael Carandang ◽  
Richard P. Goddeau, Jr. ◽  
Nils Henninger
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Pelvic Vein ◽  
Vein Thrombosis ◽  
Potential Source ◽  
Vein Imaging ◽  
Paradoxical Emboli

Background: A substantial proportion of ischemic strokes has no any identified underlying cause. Notably, the prevalence of a patent foramen ovale (PFO) is increased in cryptogenic stroke (CS) populations, which may serve as a conduit for paradoxical emboli originating from deep vein thrombosis (DVT) including the pelvic veins. Yet, there are no published guidelines for the assessment of pelvic veins as part of the stroke workup and few studies have systematically investigated pelvic veins as a potential source for paradoxical emboli in CS patients. Further, there is a relative paucity of data regarding pelvic DVT in CS and results have been conflicting. Hence, we sought to determine the prevalence of pelvic DVT in select CS patients with PFO who underwent magnetic resonance venography (MRV). Methods: We retrospectively identified patients (n = 50) who underwent contrast-enhanced pelvic MRV at the discretion of the treating physician for the evaluation of CS in the presence of a PFO during hospitalization at a single academic stroke center between January 2011 through December 2013. Multivariable logistic regression analyses were used to assess for factors independently associated with the presence of an abnormal MRV pelvis. Results: Patients (47 ± 13 years of age) had MRV performed 4 ± 3 days after their incident stroke. Nine patients had an abnormal MRV (18%). Of these, four (8%) had pelvic vein thrombosis and 5 (10%) a May-Thurner anatomic variant. All patients with pelvic DVT were subsequently anticoagulated with warfarin (none had abnormal hypercoagulability testing). Clinical clues suggesting paradoxical embolism were present in as many as 40% of patients. On multivariable logistic regression, a history of any risk factors predisposing to DVT (OR 6.7; coefficient 1.9; BCa 95% CI 0.08-20.2; p = 0.014) as well as the number of predisposing risk factors (OR 3.9; coefficient 1.4; BCa 95% CI 0.25-4.2; p = 0.005) predicted the presence of pelvic vein pathology on MRV. Conclusion: We demonstrate a relatively high prevalence of pelvic DVT among select CS patients emphasizing the importance of considering the pelvic veins as a potential source for emboli particularly in the presence of risk factors known to predispose DVT. Because patients were included at the treating physician's discretion, our results reflect ‘real-life' practice. Our results may be of clinical importance as inclusion of pelvic vein imaging in CS patients with PFO had impactful therapeutic and nosologic implications. Further study is needed to define patients most likely to benefit from pelvic vein imaging.

Spontaneous large right-to-left shunt and migraine headache with aura are risk factors for recurrent stroke in patients with a patent foramen ovale

2007 ◽  
Vol 120 (3) ◽  
pp. 357-362 ◽  
Author(s):  
Alessandro Giardini ◽  
Andrea Donti ◽  
Roberto Formigari ◽  
Luisa Salomone ◽  
Gualtiero Palareti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patent Foramen Ovale ◽  
Migraine Headache ◽  
Recurrent Stroke ◽  
Foramen Ovale

Patent Foramen Ovale in Adult Patients with Sickle Cell Disease and Stroke

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4084-4084
Author(s):  
Sheila Razdan ◽  
Anusha Reddy ◽  
Danielle F. Resar ◽  
John J. Strouse ◽  
Rani Hasan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Left Atrium ◽  
Sickle Cell ◽  
Patent Foramen Ovale ◽  
Invasive Procedure ◽  
Adult Patients ◽  
Foramen Ovale ◽  
Minimally Invasive Procedure ◽  
Cell Disease ◽  
Grade 3

Abstract Introduction: Stroke is a leading cause of death in adults with sickle cell disease (SCD), although little is known about the underlying pathophysiology or associated risk factors. A patent foramen ovale (PFO) or other intracardiac shunts are associated with ischemic stroke in children with SCD and young adults without SCD. PFOs are relatively common, with a prevalence of about 24% in the general population. Importantly, PFOs can be closed using a minimally invasive procedure, which could potentially prevent embolic strokes in individuals with SCD at risk for stroke. We therefore designed an epidemiological study to determine the prevalence of PFOs in adults with SCD and stroke. Methods: To identify SCD patients with stroke who had evidence for a PFO by echocardiagraph, we retrospectively reviewed charts from the Johns Hopkins Hospital. All adult patients (>18 years old) with the diagnosis of stroke followed in our Sickle Cell Program were included. PFO was diagnosed by conventional echocardiogram, color Doppler studies, and contrast studies with agitated saline (10 mls) through a peripheral IV or central venous catheter with and without a Valsalva maneuver (2 times each) to increase the sensitivity of detecting intracardiac shunting. The presence of bubbles in the left atrium, either spontaneously or after Valsalva, within five cardiac cycles was noted. PFOs or other intracardiac shunts were graded by the appearance of bubbles in the left atrium, including: Grade 1 (mild shunt with 1-10 bubbles), Grade 2 (moderate shunt with 10-25 bubbles and a distinct portion filling the left atrium), and Grade 3 (substantial shunt with >25 bubbles and complete filling of the left atrium). Brain MRI/MRAs were classified by stroke subtype and severity of cerebral vasculopathy. Age at the time of the study and stroke, gender, hemoglobinopathy, presence of a peripheral deep venous thrombosis (DVT), and evidence for other stroke risk factors (moyamoya or cerebral aneurysms) were ascertained by chart review. The study was approved by the IRB at our institution. Results: From this group of 65 adult patients with a sickling hemoglobinopathy (hemoglobin SS, SC, or S beta thalassemia) and stroke, we identified 15 patients who underwent an evaluation for a PFO or other intracardiac shunt (Table 1). The prevalence of PFO or other intracardiac shunt in these adults with SCD and a history of stroke was 40% (6/15). Of these 6 patients with SCD, PFO and stroke, 1 had hemoglobin SC and 5 had hemoglobin SS. Three of the PFOs were Grade 1 and 3 were Grade 3. Three patients with PFO and stroke also had a DVT at the time of the stroke; 3 patients with PFO and stroke also had Moyamoya. Conclusions: The high prevalence of PFOs in adults with SCD and stroke compared to the prevalence of PFOs in the general population suggest that PFOs could be a risk factor for stroke in this population. These findings also underscore the urgent need for further research to establish the role of PFOs in stroke in adults with SCD because PFOs can be closed with a minimally invasive procedure. Disclosures Naik: NHLBI: Research Funding.

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