title: Non-obstructive carotid atherosclerosis and patent foramen ovale in young adults with cryptogenic stroke.
abstract: Up to 50% of ischaemic strokes in young adults are classified as cryptogenic despite extensive work-up. We sought to evaluate the prevalence of non-obstructive carotid atherosclerosis (NOCA) and its association with patent foramen ovale (PFO) in young adults with cryptogenic stroke (CS).
  
  
  
  Patients aged 18-54 years, consecutively treated for first-ever CS in an academic stroke service, were included. NOCA was assessed using carotid ultrasound examination and was defined as carotid plaque with <50% stenosis. PFO was diagnosed with transesophageal echocardiography.
  
  
  
  A total of 164 patients [mean age (SD) = 43.7 (8.5) years; 104 men] were included. A PFO was found in 79/164 (48.2%) patients. NOCA was demonstrated in 41/164 (25%) patients. NOCA was more common in patients without PFO [37.6% vs. 11.4%, P < 0.001; adjusted odds ratio (95% confidence interval), 0.24 (0.10-0.56)]. Older age (P = 0.046) and subcortical location of cerebral infarct (P = 0.015) were also associated with the absence of PFO, whereas hypertension, diabetes and smoking were not.
  
  
  
  This study demonstrates that NOCA is common in young adults with CS. NOCA is negatively associated with PFO. Detecting NOCA is an important component of stroke investigation in young adults.
authors.affiliation: Department of Neurology, Toulouse University Hospital, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Jaffre
authors.affiliation: Department of Neurology, Toulouse University Hospital, Toulouse, France.
authors.forename: B
authors.initials: B
authors.lastname: Guidolin
authors.affiliation: Department of Epidemiology and INSERM U1027, Toulouse University Hospital, Toulouse, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Ruidavets
authors.affiliation: Department of Neurology, Toulouse University Hospital, Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Nasr
authors.affiliation: Department of Neurology, Toulouse University Hospital, Toulouse, France.
authors.forename: V
authors.initials: V
authors.lastname: Larrue
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult
keywords: carotid atherosclerosis; cryptogenic stroke; patent foramen ovale; young adult