@article{3120332,
    title = "Carotid Atherosclerosis and Patent Foramen Ovale in Embolic Stroke of Undetermined Source",
    author = "Ntaios, G. and Sagris, D. and Strambo, D. and Perlepe, K. and Sirimarco, G. and Georgiopoulos, G. and Nannoni, S. and Korompoki, E. and Manios, E. and Makaritsis, K. and Vemmos, K. and Michel, P.",
    journal = "Journal of Stroke and Cerebrovascular Diseases",
    year = "2021",
    volume = "30",
    number = "1",
    publisher = "W.B. Saunders",
    issn = "1052-3057",
    doi = "10.1016/j.jstrokecerebrovasdis.2020.105409",
    keywords = "adult;  aged;  Article;  cardioembolic stroke;  carotid atherosclerosis;  cerebrovascular accident;  comparative study;  diabetes mellitus;  dyslipidemia;  embolic stroke of undetermined source;  female;  human;  hypertension;  major clinical study;  male;  obesity;  patent foramen ovale;  pathogenesis;  pathogenicity;  prevalence;  priority journal;  risk of paradoxical embolism score;  scoring system;  smoking;  transesophageal echocardiography;  transient ischemic attack;  transthoracic echocardiography;  carotid artery disease;  clinical trial;  diagnostic imaging;  incidence;  middle aged;  multicenter study;  patent foramen ovale;  retrospective study;  risk assessment;  risk factor, Adult;  Aged;  Carotid Artery Diseases;  Embolic Stroke;  Female;  Foramen Ovale, Patent;  Humans;  Incidence;  Male;  Middle Aged;  Prevalence;  Retrospective Studies;  Risk Assessment;  Risk Factors",
    abstract = "Background: Carotid atherosclerosis and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear. Aim: To investigate the relation between carotid atherosclerosis and likely pathogenic PFO in patients with ESUS. We hypothesized that ipsilateral carotid atherosclerotic plaques are less prevalent in ESUS with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO. Methods: The presence of PFO was assessed with transthoracic echocardiography with microbubble test and, when deemed necessary, through trans-oesophageal echocardiography. The presence of PFO was considered as likely incidental if the RoPE (Risk of Paradoxical Embolism) score was 0–6 and likely pathogenic if 7–10. Results: Among 374 ESUS patients (median age: 61years, 40.4% women), there were 63 (49.6%) with likely incidental PFO, 64 (50.4%) with likely pathogenic PFO and 165 (44.1%) with ipsilateral carotid atherosclerosis. The prevalence of ipsilateral carotid atherosclerosis was lower in patients with likely pathogenic PFO (7.8%) compared to patients with likely incidental PFO (46.0%) or patients without PFO (53.0%) (p<0.001). After adjustment for multiple confounders, the prevalence of ipsilateral carotid atherosclerosis remained lower in patients with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO (adjusted OR=0.32, 95%CI:0.104-0.994, p=0.049). Conclusions: The presence of carotid atherosclerosis is inversely related to the presence of likely pathogenic PFO in patients with ESUS. © 2020 Elsevier Inc."
}