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  • Title: Spontaneous large right-to-left shunt and migraine headache with aura are risk factors for recurrent stroke in patients with a patent foramen ovale.
    Author: Giardini A, Donti A, Formigari R, Salomone L, Palareti G, Guidetti D, Picchio FM.
    Journal: Int J Cardiol; 2007 Sep 03; 120(3):357-62. PubMed ID: 17166607.
    Abstract:
    BACKGROUND: We sought to determine whether migraine headache with aura (MHA) and spontaneous large right-to-left (R-L) shunt are risk factors for recurrent cerebral ischemic events in cryptogenic stroke patients with a patent foramen ovale (PFO). METHODS: 140 patients with a PFO and cryptogenic stroke underwent transcatheter defect closure at our institution at a mean age of 45+/-13 years. We retrospectively analyzed follow-up data from the first cerebral ischemic event to the time of PFO closure. Before the procedure, all patients underwent transesophageal echocardiography (TEE); Transcranial Doppler scanning (TCD) was additionally performed on the last 59 patients. We analyzed the impact of MHA, thrombophilia, spontaneous large R-L shunt, and atrial septal aneurysm (ASA) on the risk of recurrent cerebral ischemic events. RESULTS: 44 patients (31%) had had at least 1 recurrent event during a follow-up of 2.2+/-2.6 years. Patients with recurrent events were more commonly females (p=0.0001), had more often an associated thrombophilia (p=0.0077), and had a higher prevalence of spontaneously large R-L shunt both at TEE and at TCD (p<0.05). They also had more commonly a history of MHA (p=0.0009) and more frequent episodes of MHA (p=0.0048). Patients with MHA had a higher risk of recurrent events when compared to patients without (odds ratio 3.87, 95% CI 1.75 to 8.50). Thrombophilia (p=0.001) and spontaneous large R-L shunt (p=0.02) were independent predictors of recurrent stroke. CONCLUSIONS: In cryptogenic stroke patients with a PFO, a history of MHA, large spontaneous large R-L shunt, and thrombophilia are all associated with a higher risk of recurrent events.
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