Clinical and infarction patterns of <scp>PFO</scp>‐related cryptogenic strokes and a prediction model

He, Dan; Shi, Qiang; Xu, Guangjing; Hu, Zheng; Li, Xuefei; Li, Qian; Guo, Yinping; Xu, Shabei; Lin, Yongbo; Yu, Zhiyuan; Wang, Wei; Luo, Xiang

doi:10.1002/acn3.647

Cited by 12 publications

(9 citation statements)

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“…Individuals with migraine are at a higher risk for stroke [18]. Recent studies have demonstrated that PFO is implicated in stroke, especially cryptogenic stroke, and the prevalence of PFO in patients with cryptogenic stroke is much higher than that in the normal healthy population [7]. Transcatheter closure of PFO is superior to medical therapy in reducing the recurrence of stroke [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…The overall incidence is between one-quarter and one-third of individuals [4,5]. Recent studies have confirmed that PFO is a risk factor for cerebral events, such as cryptogenic stroke, transient ischemic attacks (TIA), migraine headaches, and hypoxemia [6][7][8]. PFO may act as the pathway of thrombi from the venous circulation to the cerebral circulation and could cause paradoxical embolisms, even inducing transient arrhythmia, both of which are recognized as potential underlying mechanisms [7,9,10].…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Contrast Transthoracic Echocardiography and Contrast Transcranial Doppler for the Detection of Patent Foramen Ovale Related to Cryptogenic Stroke

Yang

Zhang

Wang

et al. 2020

BioMed Research International

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Background. Patent foramen ovale (PFO) has been linked to the pathophysiology of cryptogenic stroke. Contrast transesophageal echocardiography (cTEE) is the current gold standard for PFO diagnosis, but it has the disadvantage of being semi-invasive and does not exempt from risks. As a diagnostic test, the efficacy of contrast transthoracic echocardiography (cTTE) and contrast transcranial Doppler (cTCD) is controversial. This study is aimed at investigating the efficacy of cTTE and cTCD versus cTEE in PFO detection, exploring a more cost-effective and reliable method for the diagnosis of PFO related to cryptogenic stroke. Methods. From August 2019 to January 2020, a total of 213 patients with suspected PFO were included in our study. All patients underwent cTEE, cTCD, and cTTE examinations. cTTE3 was named for using a cutoff of 3 beats to detect PFO during cTTE, and cTTE5 represented a cutoff of 5 beats. A cutoff of cTCD grade III was named cTCD III. A cutoff of grade IV was named cTCD IV. cTTE3+cTCD IV was used for the combination of a cutoff of 3 beats during cTTE with grade IV of cTCD. cTTE5+cTCD III combined a cutoff of 5 beats during cTTE with cTCD grade III. Taking cTEE as the gold standard, we compared the sensitivity, specificity, negative likelihood ratio (-LR), and misdiagnosis rate for PFO detection among the above methods. Results. A total of 161 of 213 (76%) patients had PFO confirmed by cTEE. With the spontaneous Valsalva maneuver, the sensitivity, specificity, negative likelihood ratio (-LR), and misdiagnosis rate of cTTE3 in PFO diagnosis were 60%, 90%, 44%, and 10%, respectively, and those for cTTE5 were 76%, 78%, 31% and 22%, respectively. The sensitivity, specificity, negative likelihood ratio (-LR), and misdiagnosis rate of cTCD III were 80%, 71%, 29%, and 29%, respectively, while those for cTCD IV were 55%, 90%, 49%, and 10%, respectively. When cTTE and cTCD were combined to diagnose PFO, the specificity and misdiagnosis rate were significantly improved, especially cTTE3+cTCD IV, with 100% specificity and a misdiagnosis rate of 0. Conclusion. cTTE or cTCD can be used for preliminary PFO related to cryptogenic stroke findings. The combination of the two methods can improve the specificity of PFO diagnosis, especially using the cutoff of cTTE3+cTCD IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Efficacy of Contrast Transthoracic Echocardiography and Contrast Transcranial Doppler for the Detection of Patent Foramen Ovale Related to Cryptogenic Stroke

Yang

Zhang

Wang

et al. 2020

BioMed Research International

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“…It is also known that the maximum blood flow velocity in the IJV is 1/3-1/2 of the peak systolic blood flow velocity (VPS cm/s) by CCA. Knowing the cross-sectional areas of the IJV and CCA, as well as the peak systolic velocity of the CCA in each case, it is possible to determine the "optimal" speed from the IJV and compare it with the actual one using formulas (1) and (2)…”

Section: Methodsmentioning

confidence: 99%

“…Despite the fact that at present, arterial stroke is quite well studied, approaches to the diagnosis and treatment of 22-30% of cases in its classification are developed and systematized for cryptogenic stroke [1]. Indeed, the etiology of a stroke cannot always be determined, and the cause of its occurrence remains unknown [2][3][4]. Generally, the term "stroke" refers to cerebral artery disease.…”

Section: Introductionmentioning

confidence: 99%

Brachiocephalic Vessels Ultrasound Index of Arteriovenous Ratio (IAVR) and Headache as a Diagnostic Tool for Intracranial Venous Stasis in Arterial/Venous Ischemic Stroke’s Differentiation

Semenov¹,

Elena²,

Alexey³

et al. 2019

J Neuroimaging Psychiatry Neurol

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Identification of signs of intracranial venous stasis using ultrasound methods in combination with determination of headache intensity according to the visual-analogue scale allows us to suspect the venous genesis of ischemic stroke before using neuroimaging methods, which can contribute to the selection of adequate therapy and to improve the prognosis and long-term outcomes of the disease. Objective: To study the prognostic value of a complex of clinical demographic and instrumental indicators for developing a model for early differential diagnosis of ischemic stroke of arterial and venous origin. Material and Methods: Examined 124 patients with ischemic stroke: 22 with venous stroke due cerebral venous sinus thrombosis (VIS), 53.5±16.7y and 102 with atherothrombotic stroke (AIS), 68.3±12.1y which were verified by native CT; CT-angiography, PCT (perfusion CT: CBF, CBV, MTT), brachiocephalic vessels ultrasound index of arteriovenous ratio (IAVR) and transcranial duplex scanning for all. IAVR was obtained due duplex scanning of carotid common arteries (CCA) and internal jugular veins (IJV) according to the formula: V max IJV optimal =2S CCA × Vps CCA/ 3S IJV……… (1) IAVR = max IJV actual / V max IJV optimal × 100%, where……… (2) IAVR-index of arteriovenous ratio, (%) Vps CCA-peak systolic velocity of the CCA, cm/s Vmax IJV-maximum blood flow velocity, cm/s. S-vessel cross-sectional area, cm 2 , as well as. To assess the neurological status of patients, rating scales were used, including a visually analog headache intensity scale. Results: The greatest prognostic significance was possessed by such parameters as the indicator of arteriovenous blood flow ratio and the value of headache intensity on a visual-analogue scale. A model for the differential diagnosis of AIS and VIS, which has high specificity and sensitivity, has been developed. Velocity indicators in the veins of Rosenthal and the vein of Galen are additional signs of intracranial venous stasis.

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“…In the past, PFO is deemed as a significant phenomenon that is highly correlated with migraine headaches, cryptogenic stroke, and other common mental disorders. Hence, more and more studies have focused on PFO-RLS, in terms of RLS-related diseases [ 1 , 2 ]. While in recent years, several studies indicated that other types of RLS, other than PFO-RLS, are not uncommon, with the incidence rate between 20 and 41%.…”

Section: Introductionmentioning

confidence: 99%

The Value of Contrast-Enhanced Transesophageal Echocardiography in the Detection of Cardiac Right-to-Left Shunt Related with Cryptogenic Stroke and Migraine

Zhang

Huang

Lan

et al. 2020

BioMed Research International

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Purpose. To analyze the characteristics of right-to-left shunt (RLS) in patients with cryptogenic stroke and migraine by contrast-enhanced transesophageal echocardiography (c-TEE). Methods. The study population consisted of 330 patients with cryptogenic stroke and 330 patients with migraine who suspected PFO. All of them received c-TEE examination successfully. In terms of c-TEE analyses, RLS could be diagnosed when microbubbles were visualized in the transition from the right atrium to the left atrium. For semiquantitative analysis, a small amount of RLS was grade 1, indicating 1-10 microvesicles per frame could be seen in the left atrium, a moderate amount of RLS was grade 2, indicating 11-30 microvesicles per frame could be seen in the left atrium, and a large amount of RLS was grade 3, indicating more than 30 microvesicles per frame, or the left atrium is filled with microvesicles. Results. A total of 660 patients were analyzed in the study. PFO-RLS was detected in 348 (348/660, 52.7%) cases by TEE, while in 392 (392/660, 59.3%) cases by c-TEE. Simultaneously, P-RLS was detected in 239 (239/660, 36.2%) cases by c-TEE. Among 330 patients with cryptogenic stroke, PFO-RLS was detected in 198 cases; according to the c-TTE method (198/330, 60.0%), concurrently, 83 participants suffered from PFO-RLS and P-RSL (83/330, 25.1%), including 1 case with PFO and pulmonary arteriovenous fistula. Among 330 patients with migraine, PFO-RLS was detected in 194 cases; according to the c-TTE method (194/330, 58.7%), specifically, 90 participants suffered from PFO-RLS and P-RSL (90/330, 27.2%). There was no statistical significance between the two groups. P-RLS singly was detected in 28 cases with cryptogenic stroke, while in 38 cases with migraine, excluding from pulmonary arteriovenous fistula by CTA examination. In addition, semiquantitative results on c-TTE grading of RLS were compared between the two groups: grade 1 RLS in the migraine group (144/322) was significantly higher than that in the cryptogenic stroke group (71/309) ( P < 0.05 ). Grade 3 RLS in the cryptogenic stroke group (113/309) was significantly higher than that in the migraine group (67/322) ( P < 0.05 ). For grade 2 RLS, there was no statistical difference between the two groups ( P = 0.12 ). Conclusions. c-TEE can increase the positive rate of PFO diagnosis compared with TEE color Doppler. There is no significant difference in the incidence of PFO-PLS and P-RLS between the cryptogenic stroke group and the migraine group. The grades 2-3 RLS are mainly detected in the cryptogenic stroke group, while grades 1-2 RLS are mostly detected in the migraine group.

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Clinical and infarction patterns of PFO‐related cryptogenic strokes and a prediction model

Cited by 12 publications

References 44 publications

The Efficacy of Contrast Transthoracic Echocardiography and Contrast Transcranial Doppler for the Detection of Patent Foramen Ovale Related to Cryptogenic Stroke

The Efficacy of Contrast Transthoracic Echocardiography and Contrast Transcranial Doppler for the Detection of Patent Foramen Ovale Related to Cryptogenic Stroke

Brachiocephalic Vessels Ultrasound Index of Arteriovenous Ratio (IAVR) and Headache as a Diagnostic Tool for Intracranial Venous Stasis in Arterial/Venous Ischemic Stroke’s Differentiation

The Value of Contrast-Enhanced Transesophageal Echocardiography in the Detection of Cardiac Right-to-Left Shunt Related with Cryptogenic Stroke and Migraine

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