Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105409. doi: 10.1016/j.jstrokecerebrovasdis.2020.105409. Epub 2020 Nov 1.
Carotid atherosclerosis and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear.
To investigate the relation between carotid atherosclerosis and likely pathogenic PFO in patients with ESUS. We hypothesized that ipsilateral carotid atherosclerotic plaques are less prevalent in ESUS with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO.
The presence of PFO was assessed with transthoracic echocardiography with microbubble test and, when deemed necessary, through trans-oesophageal echocardiography. The presence of PFO was considered as likely incidental if the RoPE (Risk of Paradoxical Embolism) score was 0-6 and likely pathogenic if 7-10.
Among 374 ESUS patients (median age: 61years, 40.4% women), there were 63 (49.6%) with likely incidental PFO, 64 (50.4%) with likely pathogenic PFO and 165 (44.1%) with ipsilateral carotid atherosclerosis. The prevalence of ipsilateral carotid atherosclerosis was lower in patients with likely pathogenic PFO (7.8%) compared to patients with likely incidental PFO (46.0%) or patients without PFO (53.0%) (p<0.001). After adjustment for multiple confounders, the prevalence of ipsilateral carotid atherosclerosis remained lower in patients with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO (adjusted OR=0.32, 95%CI:0.104-0.994, p=0.049).
The presence of carotid atherosclerosis is inversely related to the presence of likely pathogenic PFO in patients with ESUS.
颈动脉粥样硬化和可能的致病性卵圆孔未闭（PFO）是不明来源栓塞性卒中（ESUS）患者的两个潜在栓塞源。ESUS 患者这两种机制之间的关系尚不清楚。
探讨 ESUS 患者颈动脉粥样硬化与可能致病性 PFO 之间的关系。我们假设，与可能偶发的 PFO 或无 PFO 的 ESUS 患者相比，ESUS 伴可能致病性 PFO 的患者中同侧颈动脉粥样硬化斑块的发生率较低。
采用经胸超声心动图微泡试验评估 PFO 的存在，并在必要时通过经食管超声心动图进行评估。如果 RoPE（矛盾栓塞风险）评分在 0-6 之间，则认为 PFO 为偶发的，在 7-10 之间则为致病性的。
在 374 名 ESUS 患者（中位年龄：61 岁，40.4%为女性）中，63 名（49.6%）为偶发的 PFO，64 名（50.4%）为可能致病性的 PFO，165 名（44.1%）为同侧颈动脉粥样硬化。与偶发的 PFO 患者（46.0%）或无 PFO 的患者（53.0%）相比，可能致病性 PFO 患者的同侧颈动脉粥样硬化发生率较低（7.8%）（p<0.001）。调整了多个混杂因素后，与偶发的 PFO 患者或无 PFO 的患者相比，可能致病性 PFO 患者的同侧颈动脉粥样硬化发生率仍较低（调整后的 OR=0.32，95%CI：0.104-0.994，p=0.049）。
在 ESUS 患者中，同侧颈动脉粥样硬化的存在与可能的致病性 PFO 的存在呈负相关。
