Patent foramen ovale is not associated with an increased risk of stroke recurrence.
OBJECTIVE
Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and recurrent stroke in an unselected population sample.


METHODS
We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD-based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow-up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow-up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause.


RESULTS
Follow-up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt-carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41-1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41-3.29])


CONCLUSIONS
Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it.
Feurer
R
R
Department of Neurology, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany. regina.feurer@gmx.de
Sadikovic
S
S
Sepp
D
D
Esposito
L
L
Schleef
M
M
Bockelbrink
A
A
Schwarze
J
J
Hemmer
B
B
Sander
D
D
Poppert
H
H
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000209:etiology; D009460:Neurologic Examination; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; D012148:Restless Legs Syndrome / Q000150:complications / Q000209:etiology; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods
D010975:Platelet Aggregation Inhibitors