Article Figures & Data
Figures
- Figure 1
Transcranial Doppler detection of the right-to-left shunt missed by transoesophageal echocardiography with sedation. Microemboli identified as high-intensity transient signals related to the injection of bubbles (agitated saline) can be graded as follows: grade 0, no microemboli detected in 60 s; grade 1, 1–10 microemboli; grade 2, 11–30 microemboli; grade 3, 31–100 microemboli; grade 4, 101–300 microemboli; grade 5, >300 microemboli. (Reproduced from Tobe et al 5 with permission from Elsevier.)
- Figure 2
Relationship between the RoPE score and both the PFO-attributable stroke fraction (blue bars) and estimated risk of recurrent cerebral ischaemic events (red bars). Higher RoPE scores are associated with a greater likelihood that the stroke was causally related to PFO, but are also associated with a lower risk of subsequent stroke. PFO, patent foramen ovale; RoPE, Risk of Paradoxical Embolism; TIA, transient ischaemic attack.
Tables
- Table 1
The Risk of Paradoxical Embolism score (maximum of 10 points)
Characteristics Points Vascular risk factors No hypertension 1 No diabetes mellitus 1 No prior stroke or transient ischaemic attack 1 Non-smoker 1 Age (years) 18–29 5 30–39 4 40–49 3 50–59 2 60–69 1 ≥70 0 Stroke features Cortical infarction 1 - Table 2
Summary of results from five randomised trials of PFO closure
Trial (year) N PFO closure device (incidence rate) Medical therapy (incidence rate) HR (95% CI) P values CLOSURE-1 (2012) 909 STARFlex (2.6) AP/AC (3.1) 0.78 (0.45 to 1.35) 0.37 PC Trial (2013) 414 Amplatzer (0.8) AP/AC (1.3) 0.63 (0.24 to 1.62) 0.34 RESPECT (long term) (2017) 980 Amplatzer (0.6) AP/AC (1.1) 0.55 (0.31 to 1.0) 0.046 CLOSE (2017) 473 Multiple (0.0) AP/AC (1.2) 0.03 (0.00 to 6.18) <0.001 REDUCE (2017) 664 Gore HELEX or CARDIOFORM (0.4) AP (1.7) 0.23 (0.09 to 0.62) 0.002 Incidence rate indicates the trial’s primary endpoint rate per 100 person-years.
AC, anticoagulant; AP, antiplatelet; PFO, patent foramen ovale; RESPECT, Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment; PC, Percutaneous Closure of Patent Foramen Ovale in Cryptogenic Embolism Trial.
