ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardioneurology
Predictors of recurrent ischemic stroke: Anatomical characteristics of patent foramen ovale
Provisionally accepted
- 1Shanxi Academy of Medical Sciences, Taiyuan, China
- 2Shanxi Medical University, Taiyuan, China
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Background Percutaneous closure of patent foramen ovale (PFO) is effective in preventing PFO-related stroke recurrence. Considerable further research aimed at acquiring relevant data is needed to enable reliable identification of the subgroup of patients with PFO who would benefit from such closure. Objectives This study aimed to select optimal candidates for PFO closure; we used echocardiography to assess various anatomical features of PFO, and then determined the value of those features for predicting recurrent PFO-related stroke. Methods We used echocardiography to analyze selected anatomical characteristics of PFO, including atrial septal aneurysms (ASA), right-to-left shunts, PFO width, and tunnel length, in patients with PFO-related stroke. The participants underwent PFO closure, mostly plus medication, or medication-only and were followed up for at least 2 years. We compared the rates of recurrent stroke within 2 years between the two groups, and the anatomical characteristics of PFO between patients with and without recurrent stroke using mixed effects Cox models. Results The study comprised 207 patients(120 males, 54.17%). Percutaneous PFO closure was successfully performed in 120 patients(PFO closure group), while 87 received medication-only therapy(medication-only group). After 2 years of follow-up, the risk of recurrent PFO-related ischemic stroke was was significantly lower in the PFO closure group (0.83%) than in the medication-only group (9.2%). The combination of anatomical features of ASA and large right-to-left shunts was associated with recurrent PFO-related stroke. Presence of an ASA alone was independently associated with recurrent PFO-related stroke (B=2.43, hazard ratio=11.37; 95% CI: 1.53–85.14; P=0.012). Conclusions The anatomical features of ASA and large right-to-left shunts are associated with recurrent PFO-related stroke in patients with PFO. These patients may derive the most benefit from PFO closure because of the associated greater reduction in absolute risk.
Keywords: cryptogenic stroke, patent foramen ovale, recurrent, transesophageal echocardiography, transthoracic echocardiography
Received: 01 Aug 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Chen, Fang, Yang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Li-ping Liu, liuliping1600@sina.com
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