To outline the real-world management of individuals with PFO who have experienced ischemic stroke or TIA and to investigate the AS5F score for evaluating AF risk, emphasizing its potential role in clinical decision-making.
Key Findings:
62 out of 188 individuals received PFO closure, showing younger age and fewer cardiovascular risk factors, with statistical significance noted.
Closure cohort had a higher RoPE score (6.0 ± 1.7 vs. 4.1 ± 1.5; p < 0.001), indicating a stronger association with PFO-related stroke.
AS5F score was lower in closure individuals but higher in those with AF (p < 0.001), highlighting the need for careful risk assessment.
In patients aged ≥60 years, higher AS5F scores correlated with AF (cut-off 3.8; p = 0.026), suggesting age-related risk factors.
More than half of individuals with recurrent events were categorized as cryptogenic, indicating potential gaps in current diagnostic practices.
Interpretation:
The study highlights practical decision-making in PFO-related stroke management and suggests that while RoPE and PASCAL scores are important, a systematic AF risk evaluation may provide additional benefits, particularly for older patients, thereby enhancing clinical outcomes.
Limitations:
Moderate sample size, especially among senior patients, which may limit the generalizability of findings.
Findings should be viewed as exploratory and hypothesis-generating, necessitating further research to validate results.
Conclusion:
The significance of PFO in recurrent strokes may be undervalued, indicating a need for comprehensive risk assessment in clinical practice, particularly in light of the study's findings on AF risk and cryptogenic strokes.
by Felix Müller, Arda Civelek, Luis Weitbrecht, Lukas Badura, Kai Helge Schmidt, Florian Schlotter, Philipp Lurz, Stavros V. Konstantinides, Karsten Keller, Klaus Gröschel, Marianne Hahn, Timo Uphaus
In this procedural case review, vascular surgeon Dr. Samuel Steerman performs a right carotid endarterectomy on a woman in her 60s who experienced a stroke related to carotid artery plaque.
