CLINICAL PATTERN IN PFO-ASSOCIATED STROKE
Keywords:
PFO; cryptogenic stoke; trigger factorsAbstract
Patent foramen ovale (PFO) has been documented as a cause of stroke in young patients. The aim is to determine the prevalence, clinical pattern and trigger factors in young patients with PFO-associated stroke.
We prospectively examined the prevalence of PFO–associated stroke in 95 consecutive patients, aged ≤57 years with stroke/TIA, its clinical and imaging characteristics, and relationship with physical activity - induced Valsalva trigger factors.
PFO was detected in 56.6% of patients with cryptogenic stroke (CS)/TIA and in 18.18% of patients with stroke/TIA with a known cause, and CS/TIAs with PFO were significantly more often localized in the vertebrobasilar circulation compared to strokes/TIA without a PFO (60% vs 30.43%; p=0.03). Exposure to physical activity as a trigger factor was significantly associated with the presence of PFO compared to patients without PFO (37% vs 8.33%, p=0.023). RoPe score ≥7 was obtained in 73.33% of patients with CS/TIA. In 96.67% of patients with right to left shunt detected on Bubble-cTCD with CS/TIA, a PFO was confirmed by TEE and percutaneous PFO closure was performed in 73.33% of patients.
Our results suggest that there is a large proportion of patients with PFO and CS/TIA, with the likelihood that PFO in their case is etiologically related to stroke. We showed that physical activity - induced Valsalva could provoke an asymptomatic PFO to become pathological, causing PFO-associated stroke in young adults, more likely in the vertebrobasilar circulation.
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