ABSTRACT
Ischemic stroke is one of the leading causes of mortality and the most important determinant of disability in developed countries. Its association with patent foramen ovale is one of the more controversial issues of the literature, also because paradoxical embolism is frequently a diagnosis of suspicion. Up to now, no clinical randomized studies unequivocally demonstrated the causality of this association. Comparing international guidelines there are substantial differences in clinical recommendations among scientific societies, which confirm the uncertainty surrounding this field. Actually, the superiority of transcatheter percutaneous closure over medical therapy alone is not confirmed, partially as a consequence of significant variability in the inclusion criteria, technical approach, peri- and post-procedural therapy among different studies. Moreover, the procedure is very recent and very few studies report prospective data about the safety and effectiveness of patent foramen ovale closure at long-term follow-up. A careful assessment of both clinical characteristics of patients and anatomical features of patent foramen ovale is very helpful to drive a personalized choice for the individual patient. On the basis of the available evidence, this review re-examines the impact of patent foramen ovale in the etiology of cryptogenic cerebrovascular events as well as the advantages and disadvantages of different treatment modalities, waiting for more scientific consensus.
Subject(s)
Foramen Ovale, Patent/complications , Stroke/etiology , Cardiovascular Diseases/etiology , Foramen Ovale, Patent/therapy , HumansABSTRACT
BACKGROUND: Patients with aortic stenosis have a high prevalence of coronary artery disease, but there is little information about the association of coronary artery disease and carotid artery disease. METHODS: The study includes 317 consecutive patients with aortic stenosis, who underwent carotid and coronary angiography during the same catheterization before aortic valve replacement. RESULTS: At univariate analysis, the prevalence of coronary artery disease was associated with (1) presence of carotid artery disease (P < .001); (2) angina pectoris as presentation symptom (P < .001); (3) age more than 65 years (P < .05); and (4) hypertension (P < .05). At multivariate analysis, only carotid artery disease, angina, and age emerged as independent predictors of coronary artery disease. The combination of 2 variables (carotid artery disease, angina) allowed the identification of 4 groups, with decreasing prevalence of coronary artery disease: (1) angina+/carotid artery disease+: 85%; (2) angina-/ carotid artery disease+: 50%; (3) angina+/carotid artery disease-: 41%; (4) angina-/carotid artery disease-: 21% (P < .001). CONCLUSION: In patients with symptomatic aortic stenosis, the presence of significant carotid artery disease is a strong marker of significant coronary artery disease.
