Skip to main content
SpringerLink
Log in

Comparison of clinical and biological differences between patent foramen ovale subtypes in ischemic stroke

  • Brief Communication
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Backgrounds

The patent foramen ovale (PFO) is an atrial septal tunnel with a flap-like opening, causing a right-to-left shunt (RLS) between the atrial chambers. There are few studies on ischemic stroke characteristics based on PFO subtypes. In this study, we investigated whether there are differences in clinical characteristics, RLS amount, and the etiology of stroke defined by the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) classification between PFO subtypes.

Methods

We retrospectively analyzed consecutive ischemic stroke patients with PFO who were admitted to the Jeonbuk National University Hospital from November 2013 to February 2015, and performed a microbubble test to detect RLS. The patients were divided into two groups according to RLS characteristics: constant RLS group and provoked RLS group. We compared the clinical characteristics and degree of RLS between the PFO subtypes.

Results

Out of 144 ischemic patients evaluated in this study, 83 (58%) were classified into the constant RLS group and 61 (42%) into the provoked RLS group. The proportion of microembolic signal (MES) grades 3 and 4 was significantly higher in the constant RLS group than in the provoked RLS group. There were no statistical differences in the distribution of TOAST classification between the two groups.

Conclusion

The constant RLS group showed a higher proportion of high-grade MES than the provoked RLS group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Data and materials availability

All datasets in this study are available upon reasonable request to the corresponding author.

References

  1. Ning M, Lo EH, Ning PC, Xu SY, McMullin D, Demirjian Z et al (2013) The brain’s heart - therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease. Pharmacol Ther 139(2):111–123

    Article  CAS  Google Scholar 

  2. Abdelghani M, El-Shedoudy SAO, Nassif M, Bouma BJ, de Winter RJ (2019) Management of patients with patent foramen ovale and cryptogenic stroke: an update. Cardiology 143(1):62–72

    Article  Google Scholar 

  3. Kim BJ, Kim NY, Kang DW, Kim JS, Kwon SU (2014) Provoked right-to-left shunt in patent foramen ovale associates with ischemic stroke in posterior circulation. Stroke 45(12):3707–3710

    Article  Google Scholar 

  4. Lee CH, Kang HG, Lee JS, Ryu HU, Jeong SK (2018) Microbubble signal and trial of org in acute stroke treatment (TOAST) classification in ischemic stroke. J Neurol Sci 390:150–155

    Article  Google Scholar 

  5. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS et al (2017) Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 377(11):1022–1032

    Article  Google Scholar 

  6. Sondergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE et al (2017) Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 377(11):1033–1042

    Article  Google Scholar 

  7. Serena J, Segura T, Perez-Ayuso MJ, Bassaganyas J, Molins A, Davalos A (1998) The need to quantify right-to-left shunt in acute ischemic stroke: a case-control study. Stroke 29(7):1322–1328

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Severance Hospital, Seoul, Republic of Korea

    Sinsoo Byun

  2. Department of Neurology, Jeonbuk National University Medical School and Hospital, 20, Geonji-ro, Deokjin-gu, Jeollabuk-do, Jeonju, 54907, Republic of Korea

    Hyun Goo Kang, Jin Ju Kang, Byoung-Soo Shin & Chan-Hyuk Lee

  3. Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea

    Hyun Goo Kang, Byoung-Soo Shin & Chan-Hyuk Lee

Authors
  1. Sinsoo Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyun Goo Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Ju Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byoung-Soo Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chan-Hyuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS drafted the manuscript and participated in the statistical analysis of the data. HG and BS reviewed the manuscript and gave valuable suggestions. JJ collected data and proposed an additional research design. CH developed the concept of the study and finalized the manuscript.

Corresponding author

Correspondence to Chan-Hyuk Lee.

Ethics declarations

Ethics approval

This study was approved by the Jeonbuk National University Hospital Review Committee (CUH2016-06–012).

Consent to participate

The Jeonbuk National University Hospital Review Committee waived the patient’s informed consent.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 385 KB)

Supplementary file2 (PDF 33 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Byun, S., Kang, H.G., Kang, J.J. et al. Comparison of clinical and biological differences between patent foramen ovale subtypes in ischemic stroke. Neurol Sci 42, 4719–4721 (2021). https://doi.org/10.1007/s10072-021-05394-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-021-05394-w

Keywords

Search

Navigation