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Semin Thromb Hemost 2009; 35(5): 505-514
DOI: 10.1055/s-0029-1234146
© Thieme Medical Publishers

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

Michael Handke1 , Andreas Harloff2 , Christoph Bode3 , Annette Geibel3
  • 1Department of Cardiology, University Hospital Basel, Basel, Switzerland
  • 2Department of Neurology and Neurophysiology, University Hospital Freiburg, Freiburg, Germany
  • 3Department of Cardiology and Angiology, University Hospital Freiburg, Freiburg, Germany
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Publikationsverlauf

Publikationsdatum:
08. September 2009 (online)

    Lizenzen und Reprints

ABSTRACT

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 echocardiography 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.

KEYWORDS

Patent foramen ovale - cryptogenic stroke - elderly - atrial septal aneurysm - transesophageal echocardiography

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Michael HandkeM.D. 

University Hospital Basel, Department of Cardiology

Petersgraben 4, 4031 Basel, Switzerland

eMail: HandkeM@uhbs.ch