Patent Foramen Ovale and Cryptogenic Stroke: A Matter of Age?

被引:40
作者
Handke, Michael [1 ]
Harloff, Andreas [2 ]
Bode, Christoph [3 ]
Geibel, Annette [3 ]
机构
[1] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland
[2] Univ Hosp Freiburg, Dept Neurol & Neurophysiol, Freiburg, Germany
[3] Univ Hosp Freiburg, Dept Cardiol & Angiol, Freiburg, Germany
关键词
Patent foramen ovale; cryptogenic stroke; elderly; atrial septal aneurysm; transesophageal echocardiography; ATRIAL SEPTAL ANEURYSM; TRANSIENT ISCHEMIC ATTACK; CONTRAST TRANSESOPHAGEAL ECHOCARDIOGRAPHY; DEEP-VEIN THROMBOSIS; ACADEMY-OF-NEUROLOGY; PARADOXICAL EMBOLISM; CEREBROVASCULAR EVENTS; TRANSCATHETER CLOSURE; TRANSCRANIAL DOPPLER; PERCUTANEOUS CLOSURE;
D O I
10.1055/s-0029-1234146
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A patent foramen ovale (PFO) enables a right-to-left shunt in about a quarter of the population. The marked association between cryptogenic stroke and PFO supports the hypothesis that paradoxical embolism could be a relevant cause of stroke. Although this association has been described in several studies for patients <55 years of age, only limited data are available on the role of PFO in older patients. Recent Studies, however, have also shown a significant association between cryptogenic stroke and PFO in patients >55 years of age. The relationship is especially marked in the presence of atrial septum aneurysm (ASA). This finding is in accordance with previous reports indicating that PFO and concomitant ASA is a high-risk feature. Factors promoting paradoxical embolism, such as deep vein thrombosis (DVT) and elevated right-heart pressure, are more frequently encountered in older than in younger patients. Independent of age, contrast-enhanced transthoracic and transesophageal echo cardiography are the methods of choice for the detection and imaging of PFO and atrial septal aneurysm. Transcranial Doppler can be used as a screening method in patients with cryptogenic stroke to detect a right-to-left shunt. Proof of DVT strongly supports the suspicion of paradoxical embolism and should lead to oral anticoagulation. If paradoxical embolism is suspected without proof of DVT, both drug therapy with aspirin or warfarin and percutaneous closure of the PFO are available as therapeutic options. Recent studies have shown that percutaneous closure can be performed safely and with a low rate of recurrence both in older and younger patients. Thus far, however, there is no clear-cut evidence of superiority for either therapeutic strategy.
引用
收藏
页码:505 / 514
页数:10
相关论文
共 94 条
[31]   Therapeutic strategies after examination by transesophageal echocardiography in 503 patients with ischemic stroke [J].
Harloff, A ;
Handke, M ;
Reinhard, M ;
Geibel, A ;
Hetzel, A .
STROKE, 2006, 37 (03) :859-864
[32]   DIAGNOSIS OF PATENT FORAMEN OVALE BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND ASSOCIATION WITH CEREBRAL AND PERIPHERAL EMBOLIC EVENTS [J].
HAUSMANN, D ;
MUGGE, A ;
BECHT, I ;
DANIEL, WG .
AMERICAN JOURNAL OF CARDIOLOGY, 1992, 70 (06) :668-672
[33]   Increased frequency of cardioembolism and patent foramen ovale in patients with stroke and a positive travel history suggesting economy class stroke syndrome [J].
Heckmann, J. G. ;
Stadter, M. ;
Reulbach, U. ;
Duetsch, M. ;
Nixdorff, U. ;
Ringwald, J. .
HEART, 2006, 92 (09) :1265-1268
[34]  
HOFMANN T, 1990, LANCET, V336, P1421
[35]   Effect of medical treatment in stroke patients with patent foramen ovale - Patent foramen ovale in Cryptogenic Stroke Study [J].
Homma, S ;
Sacco, RL ;
Di Tullio, MR ;
Sciacca, RR ;
Mohr, JP .
CIRCULATION, 2002, 105 (22) :2625-2631
[36]   Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen ovale [J].
Homma, S ;
DiTullio, MR ;
Sacco, RL ;
Sciacca, RR ;
Mohr, JP .
STROKE, 2004, 35 (09) :2145-2149
[37]   CHARACTERISTICS OF PATENT FORAMEN OVALE ASSOCIATED WITH CRYPTOGENIC STROKE - A BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY [J].
HOMMA, S ;
DITULLIO, MR ;
SACCO, RL ;
MIHALATOS, D ;
MANDRI, GL ;
MOHR, JP .
STROKE, 1994, 25 (03) :582-586
[38]   Patent foramen ovale and stroke [J].
Homma, S ;
Sacco, RL .
CIRCULATION, 2005, 112 (07) :1063-1072
[39]   Closure of patent foramen ovale for paradoxical emboli: Intermediate-term risk of recurrent neurological events following transcatheter device placement [J].
Hung, J ;
Landzberg, MJ ;
Jenkins, KJ ;
King, MEE ;
Lock, JE ;
Palacios, IF ;
Lang, P .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (05) :1311-1316
[40]   The use and safety of transoesophageal echocardiography in the general ICU -: a minireview [J].
Hüttemann, E ;
Schelenz, C ;
Kara, F ;
Chatzinikolaou, K ;
Reinhart, K .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2004, 48 (07) :827-836