Clinical Characteristics Of Embolic Stroke Of Undetermined Source In Patients With Patent Foramen Ovale

Objective: To describe the clinical and imaging characteristics of embolism strokes of undetermined sources(ESUS)with patent foramen ovale(PFO)and explore the efficacy of transcatheter device closure in the prevention of recurrent stroke.Methods:We retrospectively included a total of 106 patients diagnosed with ESUS(acute ischemic stroke or transient ischemic attack(TIA))in the Department of Neurology,Second Hospital of Hebei Medical University from October 2017 to January 2019 in the study.68 patients with PFO diagnosed by both contrast transthoracic echocardiography(c-TTE)and transesophageal echocardiography(TEE),their general demographic data were recorded.They were divided into small PFO group(<2.0mm)(n=47),middle PFO group(2.0mm-3.9mm)(n=21)and large PFO(?4.0mm)(n=0)according to the size of PFO measured by TEE.All patients underwent cranial magnetic resonance imaging examinations.42 patients had acute infarction showed by Diffusion weighted imaging(DWI).Compare the clinical and imaging characteristics of the two groups.Of the 68 patients with PFO,2 case were excluded,50 cases were in the operation group,16 cases were in the drug group.Followed up for 3 months,6 months and 1 year then compared the recurrence of stroke between the two groups.Result: 1.The small PFO group showed a younger age(39.9 ± 10.2 vs.48.4 ± 12.9,P=0.005),higher Ro PE score(7(6-8)vs.6(5-7),P=0.009)and less resting state right-to-left shunt(RLS)(15(31.9%)vs.12(57.1%),p=0.049)compared to the middle PFO group.2.Multiple lesions in DWI were more common in the small PFO group(51.6%vs.18.2%,P=0.080),and the percentage of posterior circulation was higher in the middle PFO group(36.4%vs.22.6%,P=0.382),there was no significant difference.3.The homocysteine in the drug group was higher than in the surgery group(P=0.026).The recurrence of stroke in two groups within one year: 1 case in operation group(2.0%),3 cases in drug group(18.8%),the operation group had a lower recurrence rate(P=0.041).Conclusions:Large PFOs are are more likely to detected in elderly ESUS patients and easier to combine with resting state RLS.ESUS patients with smaller PFO are more likely to find multiple lesions in DWI imaging,while with larger PFO tend to affect posterior circulation.Patients have ESUS combined with PFO is better to receive transcatheter device closure than oral antithrombotic drugs in the prevention of stroke recurrence.