Non‐obstructive carotid atherosclerosis and patent foramen ovale in young adults with cryptogenic stroke

• Published in: European journal of neurology Vol. 24; no. 5; pp. 663 - 666
• Main Authors: Jaffre, A., Guidolin, B., Ruidavets, J.‐B., Nasr, N., Larrue, V.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.05.2017
• Subjects: Adolescent; Adult; Atherosclerosis; Brain Ischemia - diagnostic imaging; Brain Ischemia - epidemiology; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - epidemiology; carotid atherosclerosis; cryptogenic stroke; Female; Foramen Ovale, Patent - diagnostic imaging; Foramen Ovale, Patent - epidemiology; Health risk assessment; Humans; Male; Middle Aged; patent foramen ovale; Prevalence; Stroke; Stroke - diagnostic imaging; Stroke - epidemiology; Young Adult; Young adults; carotid atherosclerosis; young adult; patent foramen ovale; cryptogenic stroke
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.13275

Background and purpose Up to 50% of ischaemic strokes in young adults are classified as cryptogenic despite extensive work‐up. We sought to evaluate the prevalence of non‐obstructive carotid atherosclerosis (NOCA) and its association with patent foramen ovale (PFO) in young adults with cryptogenic stroke (CS). Methods Patients aged 18–54 years, consecutively treated for first‐ever CS in an academic stroke service, were included. NOCA was assessed using carotid ultrasound examination and was defined as carotid plaque with <50% stenosis. PFO was diagnosed with transesophageal echocardiography. Results A total of 164 patients [mean age (SD) = 43.7 (8.5) years; 104 men] were included. A PFO was found in 79/164 (48.2%) patients. NOCA was demonstrated in 41/164 (25%) patients. NOCA was more common in patients without PFO [37.6% vs. 11.4%, P < 0.001; adjusted odds ratio (95% confidence interval), 0.24 (0.10–0.56)]. Older age (P = 0.046) and subcortical location of cerebral infarct (P = 0.015) were also associated with the absence of PFO, whereas hypertension, diabetes and smoking were not. Conclusions This study demonstrates that NOCA is common in young adults with CS. NOCA is negatively associated with PFO. Detecting NOCA is an important component of stroke investigation in young adults. Click here for the corresponding questions to this CME article.