Abstract WP408: Patent Foramen Ovale in Childhood Arterial Ischemic Stroke: Prevalence and Stroke Recurrence in a Prospective Cohort
Background and Objectives: The role of patent foramen ovale (PFO) in childhood arterial ischemic stroke (AIS) is poorly understood. We aimed to define the prevalence of PFO in children with first AIS, and its relationship to recurrence.
Methods: Subjects (>28 days to <18 years) with AIS between 2006-2012 were identified from a single-center consecutive prospective cohort study. Subjects were excluded with diagnoses of congenital or acquired heart disease, moyamoya, meningitis, brain tumor, surgery of the head or neck, endovascular procedures, metabolic disorder, or hemoglobinopathy. Charts were abstracted for clinical and radiologic features, echocardiogram, and thrombophilia evaluations. Recurrent events included 1) stroke, defined as a new focal deficit with new infarction on imaging, or 2) transient ischemic event (TIA). Incidence of recurrence in children with PFO was compared to those without PFO by survival analysis. Data are given as median (range).
Results: Forty-four subjects met eligibility criteria, median age 5.8 years (0.1-17), 77% male. Echocardiogram was obtained in 42 (95%), and disclosed a PFO in 7/42 (17%), of which other stroke risk factors were present in 5. In the entire cohort, primary stroke risk factors other than PFO included cervical arterial dissection (8), intracranial focal cerebral arteriopathy (8), thrombophilia (10), CNS vasculitis (1), other (4), none (11). All subjects received antithrombotic treatment for stroke prevention, and 2 underwent endovascular PFO device closure. Follow-up was available in all subjects at median of 25 months (4-71). Incidence rate of recurrent stroke or TIA was 8/1000 - person-months, and was similar in both groups, affecting 1/7 subjects with PFO at 0.3 months, and in 6/37 subjects without PFO at median of 2.8 months (0.3-36) afterfirst stroke.
Conclusions: PFO is present in a small proportion of children with first AIS, often with other risk factors. Recurrence in children with PFO in this small cohort was similar to those without PFO. Outcomes may have been influenced by other stroke risk factors, and secondary stroke preventive treatments including PFO closure and antithrombotic treatment. The role of PFO in initial and recurrent stroke remains uncertain, and deserves further study.
- © 2012 by American Heart Association, Inc.