Patent Foramen Ovale and the Risk of Cerebral Infarcts in Acute Pulmonary Embolism—A Prospective Observational Study

Vindiš, David; Hutyra, Martin; Šaňák, Daniel; Král, Michal; Čecháková, Eva; Littnerová, Simona; Adam, Tomáš; Přeček, Jan; Hudec, Štěpán; Ječmenová, Markéta; Táborský, Miloš

doi:10.1016/j.jstrokecerebrovasdis.2017.09.004

Cited by 27 publications

(27 citation statements)

References 20 publications

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“…Of note, none of these patients had a significant carotid stenosis or suspected cardioembolic source of ischemic stroke. Even under effective oral anticoagulation, Vindiš et al (25) reported a significant difference in recurrent ischemic lesions in patients with PFO after PE, raising the question if PFO closure should be considered in some patients with PE (25).…”

Section: Discussionmentioning

confidence: 99%

“…We found six studies; detailed analyses regarding population characteristics, diagnostic measures and time to interventions after admission are outlined in Table 3 (14,(24)(25)(26)(27)(28). Overall, ischemic stroke was reported to be diagnosed within 2-22 days following after admission and was more frequent in patients with overt PFO with four studies revealing statistical significance (14,25,27,28).…”

Section: Studies On the Frequency Of Ischemic Strokes In Patients Witmentioning

confidence: 99%

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Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

2020

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Background: Venous thromboembolism (VTE) can occur simultaneously with a cryptogenic stroke (CS) linked to patent foramen ovale (PFO), given paradox thromboembolism as potential stroke cause. However, little is known on the frequency of concomitant VTE and CS. We aimed to review the literature on the frequency of VTE in patients with CS linked to PFO (primary aim) and of ischemic stroke (IS) among patients with pulmonary embolism (PE) (secondary aim). Methods: We performed a Medline search for cohort studies, written in English, with the following characteristics: (a) enrolling patients hospitalized for an acute ischemic stroke undergoing a work-up for deep venous thrombosis (DVT) and/or PE. To be included in this review, a study had to have at least a subgroup of patients with PFO; (b) the time interval between the index stroke and the work-up had to be within 40 days and the studies had to differentiate between DVT and PE. For the secondary aim, studies had to include patients with acute PE, known PFO-status and routine brain imaging on admission or within 1 year. Results: We found eight studies reporting on the frequency of VTE after an acute CS linked to PFO. Concerning DVT, the reported frequency ranged between 7 and 27%; concerning PE, it lied between 4.4 and 37%. Six studies assessed the frequency of ischemic brain lesions among patients with an acute PE. In all studies, the presence of PFO was associated with ischemic brain lesions, both at baseline and follow-up. Conclusion: VTE can be detected in patients with CS linked to PFO. While-based on the presented literature-routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Studies On the Frequency Of Ischemic Strokes In Patients Witmentioning

confidence: 99%

Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

2020

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“…Recent reports have emphasized the clinical importance of PFO among patients with PE. The prevalence of a PFO among patients with PE is reportedly 30-50%, and the presence of PFO is associated with an increased risk of cerebral embolism and death (6)(7)(8). Entrapped thrombus in the PFO, which is direct evidence of paradoxical embolism, can present with various clinical features, from low-risk PE without arterial embolism to cardiac arrest with various arterial embolisms.…”

Section: Discussionmentioning

confidence: 99%

A Successful Treatment Strategy for Paradoxical Cerebral Embolism Accompanied by Entrapped Thrombus in Patent Foramen Ovale

et al. 2020

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A 73-year-old man was transferred to our hospital with dyspnea and left hemiplegia. The diagnosis of pulmonary embolism, entrapped thrombus in patent foramen ovale (PFO), and internal carotid artery occlusion was made by imaging studies. We decided to perform endovascular treatment without the administration of tissue plasminogen activator (tPA) for cerebral embolism because of concern about further embolism caused by fragmented thrombi. After endovascular treatment, he successfully underwent surgical embolectomy for entrapped thrombus in PFO. Endovascular treatment without tPA administration and subsequent surgical embolectomy seems to be a viable treatment strategy for patients with occlusion of the large cerebral artery accompanied by entrapped thrombus in PFO.

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“…However, patients with OAC used for concomitant pulmonary embolism or at high risk of recurrence of thromboembolic events despite anticoagulant therapy may be considered as candidates for PFO closure. 57,82,83 Recognition of a causal relationship between PFO and stroke is based on an assessment of the likelihood of other potential causes of embolism and may be difficult. Tests that exclude other causes of stroke, such as 24-hour Holter electrocardiography monitoring (in patients at high risk for atrial fibrillation) and carotid ultrasound, should be performed.…”

Section: Indications For Patent Foramen Ovale Clo-mentioning

confidence: 99%

Interventional closure of patent foramen ovale in prevention of thromboembolic events. Consensus document of the Association of Cardiovascular Interventions and the Section of Grown‑up Congenital Heart Disease of the Polish Cardiac Society

et al. 2019

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considered a pathology. 3,4 It has been observed that the incidence of PFO in the population decreases with age and is about 34% in the first 3 decades of life, 25% in the fourth to eighth decades, and 20% in the ninth decade. 3-5 This is explained by late spontaneous closures of PFO or greater mortality in patients with PFO. 4 When pressure in the right atrium is increased, the duct may open and a short right-left shunt may occur; moreover, potential embolic material may enter the systemic circulation. 1-8 In addition, thrombus formation and release from the PFO channel is also possible, especially in the presence of atrial septal aneurysm (ASA). Vasoactive substances,

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Patent Foramen Ovale and the Risk of Cerebral Infarcts in Acute Pulmonary Embolism—A Prospective Observational Study

Cited by 27 publications

References 20 publications

Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

A Successful Treatment Strategy for Paradoxical Cerebral Embolism Accompanied by Entrapped Thrombus in Patent Foramen Ovale

Interventional closure of patent foramen ovale in prevention of thromboembolic events. Consensus document of the Association of Cardiovascular Interventions and the Section of Grown‑up Congenital Heart Disease of the Polish Cardiac Society

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