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Stroke Literature Synopses: Clinical Science

Paradoxical embolism via a patent foramen ovale (PFO) is a common cause of cryptogenic stroke. Because PFO is a common anatomic variant seen in 25% of the general population, clinicians are faced with the dilemma of whether a PFO is an incidental finding or stroke related. Recent clinical trials of PFO closure failed to show a benefit of closure compared with medical therapy in reducing composite primary end points. Yet, these trials may have enrolled individuals with incidental PFO.

To derive a prediction instrument to stratify patients by attributable fraction (probability that the index event was related to PFO), Kent et al performed a patient-level meta-analysis of observational cohorts of patients with cryptogenic stroke investigated for PFO by transesophageal echocardiogram or transcranial Doppler (n=3023). The patients with cryptogenic stroke with PFO were younger, less likely to have conventional risk factors or a history of transient ischemic stroke (TIA)/stroke and more likely to have large superficial infarcts than those without PFO. Multivariable logistic regression revealed that the odds of PFO presence was lower …