PFO prevalence is remarkably high in patients with cryptogenic strokes compared to the healthy population. It is considered that a part of these strokes may be attributed to paradoxical embolism or in situ thrombus formation in a PFO niche. PFO closure in appropriately selected patients using specific devices has been documented a potent secondary stroke prevention strategy. However, the optimal candidates for PFO closure are still not precisely known. PFO prevalence and PFO-associated right-to-left shunt size in healthy populations and in stroke patients may vary considerably depending on the diagnostic modality and protocol used, on age and on poorly investigated racial/ethnic disparities. All above variables may have important implications in individualizing PFO-associated stroke risk assessment and management in the forthcoming era of precision medicine.
Despite the extensive existing literature, in the majority of cases PFO-associated stroke remains a speculative diagnosis. PFO is meticulously sought for in cryptogenic stroke; however, PFO, regardless of size, may be encountered in more than one third of the normal population. Hence, stroke causality needs to take into consideration multiple co-existing -yet, little explored- factors: anatomic and functional PFO features, PFO-associated stroke mechanisms beyond paradoxical embolism, prothrombotic factors, asymptomatic pulmonary embolism, patient age and vascular profile. Furthermore, optimal selection criteria for PFO closure are still a matter of debate and the option of long-term anticoagulation vs closure needs to be addressed in large randomized trials. Authors are invited to contribute their research/experience to untangle the “gordian knot” of PFO-associated stroke.
The scope of the Research Topic is an attempt to understand all aspects of PFO-associated stroke. All types of articles are welcome (Original Research papers, Systematic Reviews and meta-analyses, Narrative reviews, Mini-Reviews, Hypothesis and Theory, Perspective, Opinion, etc). Case reports are welcome provided that they follow the journal's guidelines (https://www.frontiersin.org/journals/neurology#article-types).
Themes of particular interest are:
• PFO epidemiology in healthy population and in stroke patients with emphasis on age/sex/racial/national heterogeneity.
• PFO diagnosis by different modalities (echocardiography, transcranial ultrasound, cardiac MRI)
• Pathophysiology/mechanisms of PFO-associated stroke
• PFO-associated stroke in older patients
• Optimization of PFO-closure selection criteria
• Risks related to PFO closure and their impact on long-term management
• Optimization of antithrombotic treatment
• Future perspectives
Conflicts of Interest: Dr. Lioutas receives consulting fees from Qmetis and salary support from the NIH/NINDS. Dr. Montalescot has received funding from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cell Prothera, CSL Behring, Europa, Idorsia, IRIS-Servier, Medtronic, MSD, Novartis, Pfizer, Quantum Genomics, Sanofi-Aventis
PFO prevalence is remarkably high in patients with cryptogenic strokes compared to the healthy population. It is considered that a part of these strokes may be attributed to paradoxical embolism or in situ thrombus formation in a PFO niche. PFO closure in appropriately selected patients using specific devices has been documented a potent secondary stroke prevention strategy. However, the optimal candidates for PFO closure are still not precisely known. PFO prevalence and PFO-associated right-to-left shunt size in healthy populations and in stroke patients may vary considerably depending on the diagnostic modality and protocol used, on age and on poorly investigated racial/ethnic disparities. All above variables may have important implications in individualizing PFO-associated stroke risk assessment and management in the forthcoming era of precision medicine.
Despite the extensive existing literature, in the majority of cases PFO-associated stroke remains a speculative diagnosis. PFO is meticulously sought for in cryptogenic stroke; however, PFO, regardless of size, may be encountered in more than one third of the normal population. Hence, stroke causality needs to take into consideration multiple co-existing -yet, little explored- factors: anatomic and functional PFO features, PFO-associated stroke mechanisms beyond paradoxical embolism, prothrombotic factors, asymptomatic pulmonary embolism, patient age and vascular profile. Furthermore, optimal selection criteria for PFO closure are still a matter of debate and the option of long-term anticoagulation vs closure needs to be addressed in large randomized trials. Authors are invited to contribute their research/experience to untangle the “gordian knot” of PFO-associated stroke.
The scope of the Research Topic is an attempt to understand all aspects of PFO-associated stroke. All types of articles are welcome (Original Research papers, Systematic Reviews and meta-analyses, Narrative reviews, Mini-Reviews, Hypothesis and Theory, Perspective, Opinion, etc). Case reports are welcome provided that they follow the journal's guidelines (https://www.frontiersin.org/journals/neurology#article-types).
Themes of particular interest are:
• PFO epidemiology in healthy population and in stroke patients with emphasis on age/sex/racial/national heterogeneity.
• PFO diagnosis by different modalities (echocardiography, transcranial ultrasound, cardiac MRI)
• Pathophysiology/mechanisms of PFO-associated stroke
• PFO-associated stroke in older patients
• Optimization of PFO-closure selection criteria
• Risks related to PFO closure and their impact on long-term management
• Optimization of antithrombotic treatment
• Future perspectives
Conflicts of Interest: Dr. Lioutas receives consulting fees from Qmetis and salary support from the NIH/NINDS. Dr. Montalescot has received funding from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cell Prothera, CSL Behring, Europa, Idorsia, IRIS-Servier, Medtronic, MSD, Novartis, Pfizer, Quantum Genomics, Sanofi-Aventis
