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Patent foramen ovale and cryptogenic strokes in the stroke in young fabry patients study

Huber, Roman; Grittner, Ulrike; Weidemann, Frank; Thijs, Vincent; Tanislav, Christian; Enzinger, Christian; Fazekas, Franz; Wolf, Markus; Hennerici, Michael G. and McCabe, Dominick J H, et al. (2017) In Stroke: a journal of cerebral circulation 48(1). p.30-35
Abstract

Background and Purpose - A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. Methods - We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic... (More)

Background and Purpose - A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. Methods - We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. Results - PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; P<0,001); subdivision of cryptogenic strokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (P<0.001 versus ASCO 3 and versus ASCO 1 and 2). PFO was more commonly observed in ASCO 0- (n=271) than in ASCO 0+ patients (n=479; 48 versus 29%; P<0.001). There was no PFO-associated magnetic resonance imaging lesion pattern. Conclusions - Cryptogenic stroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke.

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publication status
published
subject
keywords
arteriosclerosis, ischemic stroke, MRI, patent foramen ovale, risk factors
in
Stroke: a journal of cerebral circulation
volume
48
issue
1
pages
6 pages
publisher
American Heart Association
external identifiers
  • scopus:85000605818
  • wos:000391944900010
ISSN
0039-2499
DOI
10.1161/STROKEAHA.116.013620
language
English
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yes
id
a59e7e90-14c1-48f1-a2dd-899ec2d97d95
date added to LUP
2017-03-31 11:45:53
date last changed
2017-09-18 11:34:40
@article{a59e7e90-14c1-48f1-a2dd-899ec2d97d95,
  abstract     = {<p>Background and Purpose - A patent foramen ovale (PFO) is disproportionately prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. A detailed stratification of these patients may improve the identification of incidental PFO. Methods - We investigated the PFO prevalence in 3497 transient ischemic attack and ischemic stroke patients aged 18 to 55 years in the prospective multicenter SIFAP1 study (Stroke in Young Fabry Patients 1) using the ASCO classification. Patients without an obvious cause for transient ischemic attack/stroke (ASCO 0) were divided into subgroups with and without vascular risk factors (ASCO 0+ and 0-). In addition, we looked for PFO-related magnetic resonance imaging lesion patterns. Results - PFO was identified in 25% of patients. Twenty percent of patients with a definite or probable cause of transient ischemic attack/stroke (≥1 grade 1 or 2 ASCO criterion; n=1769) had a PFO compared with 29% of cryptogenic stroke patients (ASCO 0 and 3; n=1728; P&lt;0,001); subdivision of cryptogenic strokes revealed a PFO in 24% of 978 ASCO 3 patients (n.s. versus ASCO 1 and 2) and a higher prevalence of 36% in 750 ASCO 0 cases (P&lt;0.001 versus ASCO 3 and versus ASCO 1 and 2). PFO was more commonly observed in ASCO 0- (n=271) than in ASCO 0+ patients (n=479; 48 versus 29%; P&lt;0.001). There was no PFO-associated magnetic resonance imaging lesion pattern. Conclusions - Cryptogenic stroke patients demonstrate a heterogeneous PFO prevalence. Even in case of less conclusive diseases like nonstenotic arteriosclerosis, patients should preferentially be considered to have a non-PFO-mediated stroke.</p>},
  author       = {Huber, Roman and Grittner, Ulrike and Weidemann, Frank and Thijs, Vincent and Tanislav, Christian and Enzinger, Christian and Fazekas, Franz and Wolf, Markus and Hennerici, Michael G. and McCabe, Dominick J H and Putaala, Jukaa and Tatlisumak, Turgut and Kessler, Christoph and von Sarnowski, Bettina and Martus, Peter and Kolodny, Edwin and Norrving, Bo and Rolfs, Arndt},
  issn         = {0039-2499},
  keyword      = {arteriosclerosis,ischemic stroke,MRI,patent foramen ovale,risk factors},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {30--35},
  publisher    = {American Heart Association},
  series       = { Stroke: a journal of cerebral circulation},
  title        = {Patent foramen ovale and cryptogenic strokes in the stroke in young fabry patients study},
  url          = {http://dx.doi.org/10.1161/STROKEAHA.116.013620},
  volume       = {48},
  year         = {2017},
}