Long-term risk of recurrent stroke in young cryptogenic stroke patients with and without patent foramen ovale

Abstract

Background: Among patients with a patent foramen ovale and cryptogenic ischemic stroke, the long-term prognosis is unclear.

Aims: This study aims to estimate the recurrence rate in young cryptogenic stroke patients with and without patent foramen ovale.

Methods: One hundred eighty-six cryptogenic stroke patients (aged 18 to 45 years) were prospectively followed up for up to five years. They were divided into two groups according to the echocardiographic presence of patent foramen ovale. All patients received aspirin (100 mgs per day) for secondary prevention.

Results: Mean age was 32.3 (SD 7.9) years. During the mean follow up of 66 months five patients with patent foramen ovale had a recurrent strokes compared with 11 patients without patent foramen ovale. The average annual rate of recurrent cerebral ischemia was 1.1% and 1.6% for patients with and without patent foramen ovale respectively. The recurrence rate did not increase with the presence of patent foramen ovale, atrial septal aneurysm or other variables. More than 60% of the reported cases achieved a good functional outcome.
 
Conclusions: Young patients with cryptogenic ischemic stroke with and without patent foramen ovale have a low recurrence rate in a long-term follow-up and most present a favorable outcome. Patent foramen ovale with or without atrial septal aneurysm did not increase the risk of recurrence.