Association of residual shunts after PFO closure with recurrent
stroke risk: Single-center experience

J 2025

Association of residual shunts after PFO closure with recurrent stroke risk: Single-center experience

GAJDUSEK, Libor; Jaroslav JANUSKA; Otakar JIRAVSKY; Libor SKNOURIL; Miloslav DORDA et al.

Základní údaje

Originální název

Association of residual shunts after PFO closure with recurrent stroke risk: Single-center experience

Autoři

Vydání

POLISH HEART JOURNAL-KARDIOLOGIA POLSKA, WARSZAWA, POLISH CARDIAC SOC, 2025, 0022-9032

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Polsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 3.800 v roce 2024

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/25:00143525

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

cryptogenic stroke; patent foramen ovale; PFO closure; residual shunt; secondary stroke prevention

Štítky

14110211, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 23. 1. 2026 10:09, Mgr. Tereza Miškechová

Anotace

V originále

Background: Literature on residual right-to-left shunts after patent foramen ovale (PFO) closure shows conflicting results regarding stroke recurrence risk, although recent data suggest increased risk with moderate and large residual shunts. Aims: To evaluate the effect of the presence and grade of residual shunt on the risk of stroke/transient ischemic attack (TIA) after PFO closure. Material and methods: We retrospectively analyzed data from a prospectively maintained registry of 498 patients who underwent PFO closure following cryptogenic stroke/TIA between 2004 and 2022. Residual shunts (RS) were classified as grade 0 (none), grade I (<10 microbubbles), grade II (10-20), or grade III (>20) using transesophageal echocardiography and transcranial Doppler at 6 and 12 months. Recurrent ischemic events during 7-year follow-up (mean 5.24 +/- 2.0 years) were assessed via medical records. Risk ratios with 95% confidence intervals adjusted for follow-up duration were calculated. Results: In the study population (median age 52 years), RS was present in 35% of patients at 6 months, decreasing to 19% at 12 months (grade II or III: 13%). The annual risk of TIA/stroke was significantly higher in patients with any RS compared to those without (risk ratio [RR], 3.57; 95% confidence interval [CI], 1.52-8.43), particularly driven by grade III shunts (RR, 3.71; 95% CI, 1.21-11.39). Conclusions: Although the incidence of residual shunting decreases overtime, residual right-to-left shunting following PFO closure is associated with a significantly increased risk of recurrent ischemic stroke or TIA.

Citovat

GAJDUSEK, Libor; Jaroslav JANUSKA; Otakar JIRAVSKY; Libor SKNOURIL; Miloslav DORDA; Petra PESOVA; Daniel MATOUS; Miroslav HUDEC; Ivan RANIC; Jaroslav JANOSEK; Tomas FURST; Adela KONDE a Vaclav PROCHAZKA. Association of residual shunts after PFO closure with recurrent stroke risk: Single-center experience. POLISH HEART JOURNAL-KARDIOLOGIA POLSKA. WARSZAWA: POLISH CARDIAC SOC, 2025, roč. 83, č. 11, s. 1268-1275. ISSN 0022-9032. Dostupné z: https://doi.org/10.33963/v.phj.108057.

@article{2549494,
   author = {Gajdusek, Libor and Januska, Jaroslav and Jiravsky, Otakar and Sknouril, Libor and Dorda, Miloslav and Pesova, Petra and Matous, Daniel and Hudec, Miroslav and Ranic, Ivan and Janosek, Jaroslav and Furst, Tomas and Konde, Adela and Prochazka, Vaclav},
   article_location = {WARSZAWA},
   article_number = {11},
   doi = {https://doi.org/10.33963/v.phj.108057},
   keywords = {cryptogenic stroke; patent foramen ovale; PFO closure; residual shunt; secondary stroke prevention},
   language = {eng},
   issn = {0022-9032},
   journal = {POLISH HEART JOURNAL-KARDIOLOGIA POLSKA},
   title = {Association of residual shunts after PFO closure with recurrent stroke risk: Single-center experience},
   url = {https://journals.viamedica.pl/polish_heart_journal/article/view/108057},
   volume = {83},
   year = {2025}
}

TY  - JOUR
ID  - 2549494
AU  - Gajdusek, Libor - Januska, Jaroslav - Jiravsky, Otakar - Sknouril, Libor - Dorda, Miloslav - Pesova, Petra - Matous, Daniel - Hudec, Miroslav - Ranic, Ivan - Janosek, Jaroslav - Furst, Tomas - Konde, Adela - Prochazka, Vaclav
PY  - 2025
TI  - Association of residual shunts after PFO closure with recurrent stroke risk: Single-center experience
JF  - POLISH HEART JOURNAL-KARDIOLOGIA POLSKA
VL  - 83
IS  - 11
SP  - 1268-1275
EP  - 1268-1275
PB  - POLISH CARDIAC SOC
SN  - 00229032
KW  - cryptogenic stroke
KW  - patent foramen ovale
KW  - PFO closure
KW  - residual shunt
KW  - secondary stroke prevention
UR  - https://journals.viamedica.pl/polish_heart_journal/article/view/108057
N2  - Background: Literature on residual right-to-left shunts after patent foramen ovale (PFO) closure shows conflicting results regarding stroke recurrence risk, although recent data suggest increased risk with moderate and large residual shunts. Aims: To evaluate the effect of the presence and grade of residual shunt on the risk of stroke/transient ischemic attack (TIA) after PFO closure. Material and methods: We retrospectively analyzed data from a prospectively maintained registry of 498 patients who underwent PFO closure following cryptogenic stroke/TIA between 2004 and 2022. Residual shunts (RS) were classified as grade 0 (none), grade I (<10 microbubbles), grade II (10-20), or grade III (>20) using transesophageal echocardiography and transcranial Doppler at 6 and 12 months. Recurrent ischemic events during 7-year follow-up (mean 5.24 +/- 2.0 years) were assessed via medical records. Risk ratios with 95% confidence intervals adjusted for follow-up duration were calculated. Results: In the study population (median age 52 years), RS was present in 35% of patients at 6 months, decreasing to 19% at 12 months (grade II or III: 13%). The annual risk of TIA/stroke was significantly higher in patients with any RS compared to those without (risk ratio [RR], 3.57; 95% confidence interval [CI], 1.52-8.43), particularly driven by grade III shunts (RR, 3.71; 95% CI, 1.21-11.39). Conclusions: Although the incidence of residual shunting decreases overtime, residual right-to-left shunting following PFO closure is associated with a significantly increased risk of recurrent ischemic stroke or TIA.
ER  -

GAJDUSEK, Libor; Jaroslav JANUSKA; Otakar JIRAVSKY; Libor SKNOURIL; Miloslav DORDA; Petra PESOVA; Daniel MATOUS; Miroslav HUDEC; Ivan RANIC; Jaroslav JANOSEK; Tomas FURST; Adela KONDE a Vaclav PROCHAZKA. Association of residual shunts after PFO closure with recurrent stroke risk: Single-center experience. \textit{POLISH HEART JOURNAL-KARDIOLOGIA POLSKA}. WARSZAWA: POLISH CARDIAC SOC, 2025, roč.~83, č.~11, s.~1268-1275. ISSN~0022-9032. Dostupné z: https://doi.org/10.33963/v.phj.108057.

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