Current Challenges and Future Directions in Handling Stroke Patients With Patent Foramen Ovale—A Brief Review

Huber, Charlotte; Wachter, Rolf; Michalski, Dominik

doi:10.3389/fneur.2022.855656

Cited by 3 publications

(2 citation statements)

References 49 publications

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“…However, there are still some disputes and problems to be solved urgently. (I) Definition of the best benefit group: In view of the inconsistent definition of the high-risk population for PFO in the existing RCT studies ( 73 ), at present, the determination of the optimal benefit population is still controversial. The SCAI guidelines still use a risk of paradoxical embolism (RoPE) score >7 as the recommended criterion ( 6 ).…”

Section: Prevention and Treatment Of Pfo-related Neurological Disordersmentioning

confidence: 99%

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Shi

Sha²,

Li³

et al. 2023

Front. Neurol.

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Patent foramen ovale (PFO) is a common congenital cardiac abnormality when the opening of the interatrial septum is not closed in adulthood. This abnormality affects 25% of the general population. With the development of precision medicine, an increasing number of clinical studies have reported that PFO is closely related to various neurological diseases such as stroke, migraine, obstructive sleep apnea, and decompression syndrome. It has also been suggested that PFO closure could be effective for preventing and treating these neurological diseases. Therefore, increasing attention has been given to the prevention, diagnosis, and treatment of PFO-related neurological diseases. By reviewing existing literature, this article focuses on the pathogenesis, epidemiology, and clinical characteristics of PFO-related neurological diseases, as well as the prevention and treatment of different neurological diseases to discuss, and aims to provide current progress for this field and decision-making evidence for clinical practice.

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Section: Prevention and Treatment Of Pfo-related Neurological Disordersmentioning

confidence: 99%

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Shi

Sha²,

Li³

et al. 2023

Front. Neurol.

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“…However, no studies regarding IS prevention through PFO closure have included cancer patients and so data are limited. 64 The rates of inferior vena cava filter implantation have also risen in cancer patients, with studies showing that their implantation is safe even in patients with advanced disease, though their benefit in terms of quality of life improvement and survival prolongation is still a matter of discussion; patients in earlier disease stages seem to profit more, being made eligible for more interventions, though careful consideration is advised, alongside the timely removal of the filter (if retrievable). 65 However, their role in stroke prevention has not been elucidated.…”

Section: Secondary Preventionmentioning

confidence: 99%

Acute reperfusion treatment and secondary prevention of cancer-related stroke: comprehensive overview and proposal of clinical algorithm

Aloizou

Palaiodimou

Aloizou

et al. 2023

Ther Adv Neurol Disord

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Cancer-related stroke (CRS), referring to ischemic stroke occurring in cancer patients without other clear etiology, represents a clinical challenge, as it is associated with unfavorable clinical outcomes including high rates of recurrence and mortality. There are scarce international recommendations and limited consensus statements on CRS management. For this comprehensive overview, the available studies/reviews/meta-analyses on the use of acute reperfusion and secondary prevention treatments for cancer patients with ischemic stroke, focusing on antithrombotic agents, were collected and summarized. A practical management algorithm was designed per the available data. In short, acute reperfusion in the form of intravenous thrombolysis and mechanical thrombectomy appears to be safe in CRS and can be considered for eligible patients, though the functional outcomes are often poor, and mostly defined by the preexisting condition. Many patients carry indications for anticoagulation, in which case vitamin K antagonists are not preferred, while low-molecular weight heparins remain the treatment of choice; direct oral anticoagulants can be alternatively considered but are contraindicated for gastrointestinal malignancies. For patients without clear anticoagulation indications, no net benefit for anticoagulation compared to aspirin has been shown. Other targeted treatment options should be evaluated in an individualized approach, alongside the appropriate management of conventional cerebrovascular risk factors. Oncological treatment should be swiftly initiated/continued. In conclusion, acute CRS remains a clinical challenge, with many patients suffering recurrent stroke, despite preventive measures. More randomized-controlled clinical trials are urgently needed to pinpoint the most effective management options for this subset of stroke patients.

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The Role of Transcranial Doppler in Patients with Cryptogenic Stroke

Kim,

Park,

et al. 2023

J Neurosonol Neuroimag

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Identifying the stroke mechanism is crucial for secondary prevention of ischemic stroke. However, approximately 20% to 30% of patients with ischemic stroke do not display a discernible cause after standard diagnostic evaluation and are classified as having cryptogenic stroke. Most cryptogenic strokes are believed to be of embolic origin, referred to as embolic stroke of undetermined source. Several potential causes, including occult atrial fibrillation, aortic arch atheroma, non-stenotic atherosclerosis, coagulopathy, and patent foramen ovale (PFO), are significant contributors to cryptogenic stroke. Among these, PFO-associated strokes often manifest as small cortical lesions in the posterior circulation and are associated with fewer traditional risk factors. Ischemic stroke is considered a high risk if there is a large PFO with significant shunting or the presence of an atrial septal aneurysm. Although transesophageal echocardiography is regarded as the gold standard for diagnosing PFO, its invasiveness, high cost, and challenges in certain stroke patients necessitate alternative approaches. Recently, transcranial Doppler (TCD) has emerged as a valuable screening tool for detecting high-risk PFOs, as supported by recent research. Accurate determination of the culprit PFO responsible for ischemic stroke remains crucial for guiding appropriate treatment decisions. This article provides a comprehensive review of the different modalities used to diagnose PFO, strategies for assessing the risk of PFO causing paradoxical embolism, and the role of TCD in patients with cryptogenic stroke caused by other etiologies.

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Current Challenges and Future Directions in Handling Stroke Patients With Patent Foramen Ovale—A Brief Review

Cited by 3 publications

References 49 publications

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Acute reperfusion treatment and secondary prevention of cancer-related stroke: comprehensive overview and proposal of clinical algorithm

The Role of Transcranial Doppler in Patients with Cryptogenic Stroke

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