This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Halperin, J. L. Articles by Fuster, V. Search for Related Content PubMed PubMed Citation Articles by Halperin, J. L. Articles by Fuster, V. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID WARFARIN Medline Plus Health Information Stroke Related Collections Echocardiography Embolic stroke Risk Factors for Stroke Stroke in Children and the Young Anticoagulants Antiplatelets Other Stroke Treatment - Surgical

(Circulation. 2002;105:2580.)
© 2002 American Heart Association, Inc.

Patent Foramen Ovale and Recurrent Stroke

Another Paradoxical Twist

Jonathan L. Halperin, MD; Valentin Fuster, MD, PhD

From the Mount Sinai Medical Center, New York, New York.

Correspondence to Valentin Fuster, MD, PhD, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1030, New York, NY 10029-6574. E-mail valentin.fuster@msnyuhealth.org

Key Words: Editorials • stroke • anticoagulants • embolism • shunt

Clinical management of patients with acute stroke and the approach used for secondary prevention depends upon clarification of pathogenesis. Although most strokes are a consequence of cerebrovascular disease, 15% to 20% of ischemic (nonhemorrhagic) strokes have been attributed to cardiogenic embolism.¹ In practice, determination of the stroke mechanism is fraught with uncertainty, particularly when the possibility of thromboembolism emanating from atherosclerotic lesions in the aorta or cervical arteries is considered. When cardiogenic embolism is suspected, cardiac ultrasound is the principal method used to identify the potential source. The finding of left atrial enlargement has been shown to bear a significant relationship to the risk of stroke in a multivariate analysis of population-based data from the Framingham Heart Study². The most frequent confounding variable is atrial fibrillation, occurring in >2 million patients in North America and in over half of all patients with cardiogenic embolism. Criteria for selection of patients with acute ischemic stroke for transesophageal echocardiography (TEE) to search for a potential cardiac source of embolism are controversial, particularly because cardiogenic embolism is often an uncertain diagnosis that is inferred merely on the basis of the finding of potential cardiac source. Even after extensive investigation, 40% of ischemic stroke patients have no clearly identifiable pathogenesis (cryptogenic stroke).³ In one study, 62% of patients younger than 60 years of age without an obvious source of cerebral infarction and 23% of those with arterial lesions had potential sources of cardiogenic embolism identified by TEE (P=0.0007 for the difference).⁴

See . . . [Full Text of this Article]

This article has been cited by other articles:

				P. T. O'Gara, S. R. Messe, E. M. Tuzcu, G. Catha, and J. C. Ring Percutaneous Device Closure of Patent Foramen Ovale for Secondary Stroke Prevention: A Call for Completion of Randomized Clinical Trials A Science Advisory From the American Heart Association/American Stroke Association and the American College of Cardiology Foundation The American Academy of Neurology affirms the value of this science advisory J. Am. Coll. Cardiol., May 26, 2009; 53(21): 2014 - 2018. [Abstract] [Full Text] [PDF]

				P. T. O'Gara, S. R. Messe, E. M. Tuzcu, G. Catha, and J. C. Ring Percutaneous Device Closure of Patent Foramen Ovale for Secondary Stroke Prevention: A Call for Completion of Randomized Clinical Trials: A Science Advisory From the American Heart Association/American Stroke Association and the American College of Cardiology Foundation The American Academy of Neurology affirms the value of this science advisory. Circulation, May 26, 2009; 119(20): 2743 - 2747. [Abstract] [Full Text] [PDF]

				C. Spies, R. Strasheim, I. Timmermanns, and R. Schraeder Patent foramen ovale closure in patients with cryptogenic thrombo-embolic events using the Cardia PFO occluder Eur. Heart J., February 1, 2006; 27(3): 365 - 371. [Abstract] [Full Text] [PDF]

				J. E. Sousa, M. A. Costa, E. M. Tuzcu, J. S. Yadav, and S. Ellis New Frontiers in Interventional Cardiology Circulation, February 8, 2005; 111(5): 671 - 681. [Full Text] [PDF]

				H. P. Adams Jr Patent Foramen Ovale: Paradoxical Embolism and Paradoxical Data Mayo Clin. Proc., January 1, 2004; 79(1): 15 - 20. [PDF]

				P. Khairy, C. P. O'Donnell, and M. J. Landzberg Transcatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli: A Systematic Review Ann Intern Med, November 4, 2003; 139(9): 753 - 760. [Abstract] [Full Text] [PDF]

				R. Castello and T. G. Brott Patent foramen ovale: friend or foe? J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1073 - 1075. [Full Text] [PDF]

				D. R. Holmes Jr and A. Cabalka Was Your Mother Right--: Do We Always Need to Close the Door? Circulation, August 27, 2002; 106(9): 1034 - 1036. [Full Text] [PDF]

				Stroke and Patent Foramen Ovale Journal Watch Cardiology, August 16, 2002; 2002(816): 7 - 7. [Full Text]

				Stroke and Patent Foramen Ovale Journal Watch (General), July 30, 2002; 2002(730): 4 - 4. [Full Text]