Imaging And Clinical Features Of Cerebral Infarction Associated With Patent Foramen Ovale

【Background】The mechanism of PFO related stroke is obscure.The present mechanism mainly is paradoxical embolism theory,Which is the small thrombi that arise in the venous system pass through the PFO during a transient right to left shunt.However,cases demonstrating a thrombus traversing the PFO are relatively few.Other possible explanations for stroke secondary to PFO but independent of paradoxical embolism include secondary cardiac arrhythmias or abnormalities of the endocardial surface of the septum or within the PFO that are a focus for thrombus formation.【Objective】To summary the neuroimaging and clinical features of PFO related cerebral infarction and explore its possible mechanism by comparing clinical and neuroimaging features of cerebral infarction caused by patent foramen ovale,atrial fibrillation and cranial artery stenosis.【Methods】In this retrospective analysis,we comparatively studied cases of cerebral ischemic stroke including 30 confirmed cases of patent foramen ovale cerebral infarction,60 cases of atrial fibrillation cerebral infarction and cranial artery stenosis cerebral infarction.Three groups were assorted according to the related blood vessels and infarction lesions to imaging types to compare the proportion of any imaging types.At the same time,we also compare the clinical data of the three groups.【Results】Comparison of the baseline data between the three groups,there was no significant difference in FPG,TC,TG,Fib,Hcy,PLT,MPV and diabetes(P > 0.05).The level of LDL-C in PFO group was lower than that of cerebral artery stenosis group(P<0.05);The age of PFO group was lower than that of cerebral artery stenosis group,and the age of cerebral artery stenosis group was lower than that of AF group(P<0.001);The male incidence of AF group was lower than that of cerebral artery stenosis group(P<0.05),but there was no difference between PFO group and the other two groups(P>0.05);The prevalence rate of hypertension in PFO group was lower than cerebral artery stenosis group(P=0.005),and there was no difference between atrial fibrillation group and cerebral artery stenosis(P>0.05);The smoking rate of atrial fibrillation group was lower than atrial fibrillation group(20.0% vs 51.1%,P=0.000),PFO group and cerebral artery stenosis group have no significant difference(43.3% vs 51.1%,P>0.05).Comparison of the imaging data between the three groups,there was no significant difference between the cortical type and the perforating branches type(P>0.05);PFO group was less frequently observed as watershed type than atrial fibrillation group(P<0.01);PFO group was more frequently observed as posterior circulational type than the other two groups(43.3% vs 15% and 17%,P=0.003,0.003).There was no significant difference between the single big infarct,multiple small infarct and multiple big infarct.PFO group was more frequently observed as a single small infarct(≤30mm)than atrial fibrillation group(56.7% vs 30.0%,P=0.012).【Conclusion】PFO related cerebral infarction mainly occurs in the middle and young people,the incidence of men more than women,smoking may incease the risk.PFO related cerebral infarction mainly distributed in vertebrobasilar artery system,usually appears as a single small infarct(≤30mm).