Document Detail


Spontaneous large right-to-left shunt and migraine headache with aura are risk factors for recurrent stroke in patients with a patent foramen ovale.
MedLine Citation:
PMID:  17166607     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We sought to determine whether migraine headache with aura (MHA) and spontaneous large right-to-left (R-L) shunt are risk factors for recurrent cerebral ischemic events in cryptogenic stroke patients with a patent foramen ovale (PFO). METHODS: 140 patients with a PFO and cryptogenic stroke underwent transcatheter defect closure at our institution at a mean age of 45+/-13 years. We retrospectively analyzed follow-up data from the first cerebral ischemic event to the time of PFO closure. Before the procedure, all patients underwent transesophageal echocardiography (TEE); Transcranial Doppler scanning (TCD) was additionally performed on the last 59 patients. We analyzed the impact of MHA, thrombophilia, spontaneous large R-L shunt, and atrial septal aneurysm (ASA) on the risk of recurrent cerebral ischemic events. RESULTS: 44 patients (31%) had had at least 1 recurrent event during a follow-up of 2.2+/-2.6 years. Patients with recurrent events were more commonly females (p=0.0001), had more often an associated thrombophilia (p=0.0077), and had a higher prevalence of spontaneously large R-L shunt both at TEE and at TCD (p<0.05). They also had more commonly a history of MHA (p=0.0009) and more frequent episodes of MHA (p=0.0048). Patients with MHA had a higher risk of recurrent events when compared to patients without (odds ratio 3.87, 95% CI 1.75 to 8.50). Thrombophilia (p=0.001) and spontaneous large R-L shunt (p=0.02) were independent predictors of recurrent stroke. CONCLUSIONS: In cryptogenic stroke patients with a PFO, a history of MHA, large spontaneous large R-L shunt, and thrombophilia are all associated with a higher risk of recurrent events.
Authors:
Alessandro Giardini; Andrea Donti; Roberto Formigari; Luisa Salomone; Gualtiero Palareti; Donata Guidetti; Fernando Maria Picchio
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Publication Detail:
Type:  Journal Article     Date:  2006-12-12
Journal Detail:
Title:  International journal of cardiology     Volume:  120     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-07-23     Completed Date:  2007-10-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  357-62     Citation Subset:  IM    
Affiliation:
Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy. alessandro5574@iol.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Female
Heart Septal Defects, Atrial / complications*,  surgery
Humans
Ischemic Attack, Transient / complications*
Male
Middle Aged
Migraine with Aura / complications*
Multivariate Analysis
Recurrence
Retrospective Studies
Risk Factors
Sex Factors
Stroke / complications*
Thrombophilia / complications

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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