Comparison of Patent Foramen Ovale and Aortic Atherosclerosis in Patients with Cryptogenic Ischemic Stroke or Transient Ischemic Attack

  • Zhian Li, Beijing Anzhen Hospital, China
  • Xiaoyan Gu, Beijing Anzhen Hospital, Capital University of Medical Sciences, China
  • Yihua He, Beijing Anzhen Hospital, Capital University of Medical Sciences, China
  • Michael Kontos, Virginia Commonwealth University, Richmond, United States
  • J V Nixon, Virginia Commonwealth University, Richmond, United States

    • Objective: To study the association of patent foramen ovale (PFO) and atheromas in the ascending aorta and aortic arch with cryptogenic stroke (CS) in < 55 yrs and ≥55 yrs old patients.
    Methods: Transesophageal echocardiographys (TEE) in 229 consecutive patients evaluated for CS were compared to TEEs in 314 patients evaluated for valve disease or endocarditis with no history of stroke (control group). The prevalence of PFO, complex atheromas in the ascending and aortic arch (protruding atheroma ≥ 4 mm thickness, presence of mobile components or presence of ≥ 2 mm surface ulceration) was determined in all patients and compared between the between CS and control patients in both younger and older groups.
    Results: The prevalence of PFO was significantly higher in patients with CS than control patients both in those <55 (31/114 (27.1%) vs 24/171 (14.0%), p=0.006) and ≥55 yrs (28/115 (24.3%) vs 21/143 (14.6%), p=0.049). Multivariate analysis showed that PFO was independently associated with CS, irrespective of the patient’s age. The prevalence of complex atheroma was similar in both groups irrespective of the patient’s age (patients <55 yrs: 11/114 (9.6%) vs 12/171 (7.0%), p=0.424; patients ≥55 yrs: 29/115 (25.2%) vs 35/143 (24.4%), p=0.891, respectively).
    Conclusion: We found a significant association of PFO with CS both in younger (<55 yrs) and older (≥55 yrs) patients. Complex atheromas in the ascending aorta and aortic arch do not appear to be associated with CS.