Subclinical atherosclerosis burden and patent foramen ovale in young and middle-aged patients with stroke of undetermined etiology: A real-life retrospective cohort study
Claudia Altamura, Giovanna Viticchi, Angelo Cascio Rizzo, Paola Maggio, Nicoletta Brunelli, Marilena Marcosano, Sergio Soeren Rossi, Vincenzo Di Lazzaro, Fabrizio Fiacco, Mauro Silvestrini, Fabrizio VernieriAbstract:
OBJECTIVES:
To characterize the subclinical atherosclerosis in a group of young and middle-aged patients with stroke of undetermined etiology, in relation to the stroke causal likelihood of patent foramen ovale (PFO).
METHODS:
We conducted a retrospective review of prospectively collected medical records of consecutive patients aged 18–60 years with a diagnosis of acute ischemic stroke of undetermined origin between January 2016 and June 2022. Patients were grouped by the PFO presence and the stroke-causal likelihood of PFO according to the PFO-Associated Stroke Causal Likelihood (PASCAL) classification system.
RESULTS:
We included 157 patients with stroke of undetermined etiology (mean age 48.2 ± 8.7 years; 43.3% female). Of these, 75 patients presented PFO. After adjusting for age and sex, the PFO+ group presented a lower mean carotid intima-media thickness (cIMT;
CONCLUSIONS:
The burden of subclinical atherosclerosis is progressively lower in patients with unlikely, possible, and probable stroke-causative PFO. These results support the idea that atherosclerosis may play a significant causal role in some patients with stroke of undetermined origin with or without PFO.