Could anatomical and functional features predict cerebrovascular events in patients with patent foramen ovale?

Background. PFO has been controversially associated with cryptogenic stroke (CS). Recently, it has been shown that a complex anatomy of PFO could enhance its embolic potential. We investigated which type of PFO morphology could be at major risk. Methods. Between March 2013 and January 2016, we prospectively enrolled 370 pts with PFO (mean age: 44.3 ± 15.1; 30% men), identified by contrast-transcranial Doppler and transesophageal echocardiography performed with the following indications: CS (42%), migraine (27%), nonspecific neurological symptoms, in the remaining cases. We analyzed the PFO anatomical features, the presence of shunt at rest and the shunt severity, classifying all the PFOs according to the current recommendations. Results. A complex lesion was found in the following cases: PFOs >4 mm (40%), severe shunt (41.5%), shunt at rest (60%), tunnel-like morphology (32%, with a tunnel length >8 mm in 28% of cases), ASA (80%), Chiari’s network or Eustachian valve (31%). In the Table 1, the results of a chi-square analysis comparing pts with CS vs. those without CS are displayed. A tunnel-like morphology was significantly more frequent in patients with CS (77.6%) than in those without CS (55.6%, p=0.04). On logistic regression analysis, only a tunnel-like morphology was associated to a major risk of CS [OR=0.36 (0.13-0.99) p = 0.04).Conclusions The pathophysiological link between CS and PFO is contradictory. Nevertheless a careful evaluation of anatomical factors could be useful for ensuring a more tailored pts management.