From the Department of Neurology (B.J.K., H.S., D.-W.K., J.S.K., S.U.K.), and Department of Cardiology (B.J.S., J.-K.S.), Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Stroke. 2013 Dec;44(12):3350-6. doi: 10.1161/STROKEAHA.113.002459. Epub 2013 Sep 26.
Subclinical atrial fibrillation (AF) and patent foramen ovale (PFO) are the major causes of cryptogenic stroke, and neuroimaging may help distinguish the cause. We compared the imaging characteristics of ischemic stroke caused by PFO (PFO-stroke) and AF (AF-stroke).
We recruited 117 patients with PFO-stroke and 358 patients with AF-stroke after excluding other causes. The lesion patterns were classified according to number, location, size, and pertinent vascular territory and were compared between the 2 groups. Occlusion of the corresponding artery and its recanalization rate were also investigated.
The lesion pattern of a PFO-stroke was more frequently observed as a single cortical infarction (34.2% versus 3.1%; P<0.001) or multiple small (<15 mm) scattered lesions (23.1% versus 5.9%; P<0.001) and in the vertebrobasilar artery territory (44.4% versus 22.9%; P<0.001). By contrast, AF-stroke was more frequently observed as a large cortico-subcortical infarction or confluent lesion (>15 mm) with additional lesions in multicirculatory territories. For a PFO-stroke, occlusion of the corresponding vessel on angiography was less frequent (34.2% versus 71.5%; P<0.001), and the neurological deficit evaluated by the National Institutes of Health Stroke Scale was mild (3.48±4.16 versus 9.15±7.35; P<0.001). The recanalization rate was also lower (57.1% versus 78.3%; P=0.007).
A PFO-stroke usually appears as a single cortical or multiple small ischemic lesions in the vertebrobasilar circulation without any visible vessel occlusion on angiography. The recanalization rate is significantly lower than in AF-stroke. These imaging characteristics of PFO-stroke may help to diagnose the mechanism and determine the treatment strategy.
亚临床心房颤动（AF）和卵圆孔未闭（PFO）是隐源性卒中的主要原因，神经影像学可能有助于区分病因。我们比较了由 PFO（PFO-卒中）和 AF（AF-卒中）引起的缺血性卒中的影像学特征。
我们排除其他原因后，招募了 117 例 PFO-卒中患者和 358 例 AF-卒中患者。根据数量、位置、大小和相关血管区域对病变模式进行分类，并比较两组之间的差异。还研究了相应动脉的闭塞及其再通率。
PFO-卒中的病变模式更常表现为单一皮质梗死（34.2%比 3.1%；P<0.001）或多个小（<15mm）散在病变（23.1%比 5.9%；P<0.001）和椎基底动脉区域（44.4%比 22.9%；P<0.001）。相比之下，AF-卒中更常表现为大皮质-皮质下梗死或融合病变（>15mm），并伴有多循环区域的其他病变。对于 PFO-卒中，血管造影上相应血管的闭塞较少见（34.2%比 71.5%；P<0.001），国立卫生研究院卒中量表评估的神经功能缺损较轻（3.48±4.16 比 9.15±7.35；P<0.001）。再通率也较低（57.1%比 78.3%；P=0.007）。
PFO-卒中通常表现为单一皮质或多个小的椎基底动脉循环缺血性病变，血管造影上无明显血管闭塞。再通率明显低于 AF-卒中。PFO-卒中的这些影像学特征可能有助于诊断机制并确定治疗策略。
