FIGHTING THE FEAR OF THE UNKNOWN
UNDERSTANDING THE COMMON CHALLENGES IN TREATING CRYPTOGENIC STROKE*
MULTIPLE CONSIDERATIONS DURING TREATMENT PLANNING
AN EVERYDAY OCCURRENCE
- Approximately one-third of ischemic strokes are cryptogenic1
- Each year, there are approximately 200,000 and 300,000 strokes in the US and the EU, respectively1,2
MULTIPLE POTENTIAL MECHANISMS
- Several mechanisms are implicated in patients with cryptogenic stroke, including but not limited to:
- Occult paroxysmal AF2
- Paradoxical embolism through a PFO2
- Substenotic atherosclerosis2
HIGHER PREVALENCE OF PFO
- Prevalence of PFO in the general population is reported between 17%-35%3
- In patients with cryptogenic stroke, PFO was found in up to 45% of cases3
POTENTIAL FOR RECURRENCE
- Rate of stroke recurrence in patients with PFO has been estimated to be 20.4% at 3 years3 and 25% at 4 years4,5
- Patients with PFO and prior cryptogenic stroke have a higher risk for further cerebrovascular events6
A RELATIVELY YOUNG PATIENT POPULATION
- Cryptogenic stroke is common in patients under 45 years of age7
- PFO is strongly associated with cryptogenic stroke in patients younger than 55 years8
- Even a relatively low recurrence rate may pose a substantial risk with the potential for a longer exposure period9
TERRIFIED OF HAVING ANOTHER STROKE
“Having no control is so scary. Walking around in fear of having another stroke, or being on major blood thinners forever. I just wanted to live a normal life without constant worry.”
–Heidi Easley, cryptogenic stroke patient at 37
THE SOLUTION: PFO CLOSURE
- Truelsen T, Piechowski-Jozwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol. 2006;13:581-598.
- Mozaffarian D, Benjamin E, Go A, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38-e360.
- Preventive Cardiology What Proportion of Stroke Is Not Explained by Classic Risk Factors? Catalina C. Ionita, MD; Andrew R. Xavier, MD; Jawad F. Kirmani, MD; Subasini Dash, MD; Afshin A. Divani, PhD; Adnan I. Qureshi, MD Disclosures Prev Cardiol. 2005;8(1):41-46.
- Homma S., Sacco R.L., Di Tullio M.R., et al., for the PICSS Investigators (2002) Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 105:2625–2631. Abstract/FREE Full TextGoogle Scholar
- Mas J-L, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011-21 and supplementary appendix.
- Kernan et al. AHA/ASA Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. 2014; 45(7):2160-2236.
- Ionita. Preventive Cardiology: https://www.medscape.com/viewarticle/499978_6
- Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med. 2007;357:2262-8.
- Love BA, Diener H. PFO: “Please figure out,” or now “Potentially Figured Out?” JACC