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Ferdinando S Buonanno - One of the best experts on this subject based on the ideXlab platform.
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abstract wp239 real time prospective measurement of aptt predicts Paradoxical Embolism in cryptogenic stroke
Stroke, 2017Co-Authors: Bo Song, Ferdinando S Buonanno, Wenjun Deng, Lindsay Fisher, Iying Chou, Max Oyer, David Mcmullin, Mingming NingAbstract:Patent foramen ovale (PFO) is an important underlying source of cryptogenic stroke (CS) associated with hematologic procoagulability. However, the association of genetically identified hyperocagulability and Paradoxical Embolism has been difficult to establish due to retrospective analysis and the limited numbers of of known genetically identified hypercoagulable conditions. In this study, we explored the utility of conventional coagulation status in PFO related stroke, as the patients may harbor genetically unidentified hyperocoagulable conditions. Method: Eligible pts were prospectively recruited in accordance with IRB, and underwent conventional coagulation testing (PT/PTT) testing within 12 hours of stroke. All patients underwent full cryptogenic workup such as MRI/MRA, mobile cardiac outpatient telemetry (>30 days), cardiac echo, and hypercoagulable testing. Results: We screened 4,831 pts admitted with acute neurologic diseases, and recruited 358 eligible acute ischemic stroke pts. 54 (15.1%) pts had CS and 32 pts had PFO related stroke. While there is no difference between PFO-related CS and PFO-unrelated CS on full hypercaogulable screen (protein S, protein C, FVL, PTGM, ATIII, APLAb, LA, hcy), aPTT was statistically significantly shortened in PFO-related stroke patients (PFO CS vs. non-PFO CS: aPTT 27.2±4.1s vs. 29.9±2.3s). ROC curve indicates early shortened aPTT can predict PFO related stroke (sensitivity 70%, specificity 81.5%, p=0.017) (see Figure). Conclusion: We found real time aPTT to be significantly shortened in patients eventually diagnosed with Paradoxical Embolism related to PFO. While studies in larger pt cohorts accounting for other potential confounders are underway, this proof-of-concept study demonstrates the importance and utility of early conventional coagulation testing in identifying Paradoxical Embolism. Pts with shortened aPTT may need additional workup for other underlying hypercoagulable conditions.
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percutaneous transcatheter closure of patent foramen ovale in patients with Paradoxical Embolism
Circulation, 2002Co-Authors: Francisco Martin, Elizabeth Doherty, Pedro J Colonhernandez, Nandita S Scott, Ignacio Inglessis, Judy Hung, Pedro L. Sánchez, Mary Etta King, Gabriel Delgado, Ferdinando S BuonannoAbstract:Background— Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with Paradoxical Embolism and PFO. Methods and Results— We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47±14 years) who underwent transcatheter closure of PFO because of Paradoxical Embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experience...
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percutaneous transcatheter closure of patent foramen ovale in patients with Paradoxical Embolism
Circulation, 2002Co-Authors: Francisco Martin, Elizabeth Doherty, Pedro J Colonhernandez, Nandita S Scott, Ignacio Inglessis, Judy Hung, Pedro L. Sánchez, Mary Etta King, Gabriel Delgado, Ferdinando S BuonannoAbstract:BACKGROUND: Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with Paradoxical Embolism and PFO. METHODS AND RESULTS: We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47+/-14 years) who underwent transcatheter closure of PFO because of Paradoxical Embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. CONCLUSIONS: Transcatheter closure of PFO is a safe and effective therapy for patients with Paradoxical Embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.
Claudia Stöllberger - One of the best experts on this subject based on the ideXlab platform.
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Search for Coagulopathy Does Not Obviate Search for Venous Thrombosis in Suspected Paradoxical Embolism
Stroke, 2003Co-Authors: Claudia Stöllberger, Josef FinstererAbstract:To the Editor: Paradoxical Embolism via a patent foramen ovale (PFO) has been suggested as a mechanism of otherwise unexplained, cryptogenic stroke.1 Paradoxical Embolism, however, can be diagnosed only if there is evidence of a venous thrombosis coexisting with arterial Embolism and right-to-left shunting via a PFO. When looking for venous thrombosis in suspected Paradoxical Embolism, the diagnostic yield depends on the interval between the event and the investigation and the used diagnostic methods.2 Diagnosing venous thrombosis in patients with suspected Paradoxical Embolism is sometimes difficult since the thrombosis (1) may be confined to the calf veins and thus only detectable by venography; (2) may be localized in places other than in the leg veins and thus not detectable by leg venography; (3) may be not the cause but the consequence of arterial Embolism; or (4) may spontaneously dissolve, re-embolize, or recanalize.3 Due to these problems, a timely search for venous thrombosis is only rarely performed in patients with suspected Paradoxical Embolism, especially if they have no clinical symptoms of thrombosis. Several strategies are possible to overcome these obstacles. The first strategy is by improving noninvasive methods to visualize venous thrombosis in different locations, like magnetic resonance venography.4 Another strategy is by search for a clotting diathesis in patients with suspected Paradoxical Embolism. This indirect strategy is based on the assumption that hypercoagulability leads to a higher incidence of venous thrombosis and thus, in the presence of a PFO, might increase the possibility of Paradoxical Embolism. Hypercoagulability can be assessed by genetic testing for factor VG1691A mutation, prothrombinG20210A variant, and TT677 genotype of methylenetrahydrofolate reductase. The risk for venous thrombosis is increased 3- to 8-fold in heterozygous carriers of the factor VG1691A mutation, 3-fold in heterozygous carriers of the prothrombinG20210A variant, and …
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Why is venous thrombosis only rarely detected in patients with suspected Paradoxical Embolism
Thrombosis research, 2002Co-Authors: Claudia Stöllberger, Josef Finsterer, Jörg SlanyAbstract:Paradoxical Embolism should only be diagnosed if three conditions are present: arterial Embolism, a cardiac right-toleft shunt, and venous thrombosis. Whereas diagnosis of peripheral or cerebral arterial Embolism is facilitated by computed tomography, angiography, and Duplex sonography, and cardiac right-to-left shunts is reliably diagnosed by transesophageal contrast echocardiography or transcranial Doppler sonography, there are only a few studies with a small number of patients that evaluate the role of the venous system in patients with suspected Paradoxical Embolism (Table 1) [1–8]. Several authors do not even mention screening for venous thrombosis as useful investigation in patients with suspected Paradoxical Embolism [9,10]. From a diagnostic prerequisite for Paradoxical Embolism, venous thrombosis has been degraded to one of several ‘‘risk factors’’ [11–13 14]. Confirming or excluding venous thrombosis in patients with suspected Paradoxical Embolism, however, is of therapeutic relevance and not only a matter of academic interest, because
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The Prevalence of Deep Venous Thrombosis in Patients with Suspected Paradoxical Embolism
Annals of internal medicine, 1993Co-Authors: Claudia Stöllberger, Jörg Slany, Irmgard Schuster, Hermann Leitner, Walther-benedikt Winkler, Ronald KarnikAbstract:Objective: To determine the prevalence of venous thrombosis in patients with suspected Paradoxical Embolism. Design: Observational study. Patients: Two hundred sixty-four patients with clinically s...
Francisco Martin - One of the best experts on this subject based on the ideXlab platform.
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percutaneous transcatheter closure of patent foramen ovale in patients with Paradoxical Embolism
Circulation, 2002Co-Authors: Francisco Martin, Elizabeth Doherty, Pedro J Colonhernandez, Nandita S Scott, Ignacio Inglessis, Judy Hung, Pedro L. Sánchez, Mary Etta King, Gabriel Delgado, Ferdinando S BuonannoAbstract:Background— Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with Paradoxical Embolism and PFO. Methods and Results— We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47±14 years) who underwent transcatheter closure of PFO because of Paradoxical Embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experience...
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percutaneous transcatheter closure of patent foramen ovale in patients with Paradoxical Embolism
Circulation, 2002Co-Authors: Francisco Martin, Elizabeth Doherty, Pedro J Colonhernandez, Nandita S Scott, Ignacio Inglessis, Judy Hung, Pedro L. Sánchez, Mary Etta King, Gabriel Delgado, Ferdinando S BuonannoAbstract:BACKGROUND: Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with Paradoxical Embolism and PFO. METHODS AND RESULTS: We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47+/-14 years) who underwent transcatheter closure of PFO because of Paradoxical Embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. CONCLUSIONS: Transcatheter closure of PFO is a safe and effective therapy for patients with Paradoxical Embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.
Josef Finsterer - One of the best experts on this subject based on the ideXlab platform.
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Search for Coagulopathy Does Not Obviate Search for Venous Thrombosis in Suspected Paradoxical Embolism
Stroke, 2003Co-Authors: Claudia Stöllberger, Josef FinstererAbstract:To the Editor: Paradoxical Embolism via a patent foramen ovale (PFO) has been suggested as a mechanism of otherwise unexplained, cryptogenic stroke.1 Paradoxical Embolism, however, can be diagnosed only if there is evidence of a venous thrombosis coexisting with arterial Embolism and right-to-left shunting via a PFO. When looking for venous thrombosis in suspected Paradoxical Embolism, the diagnostic yield depends on the interval between the event and the investigation and the used diagnostic methods.2 Diagnosing venous thrombosis in patients with suspected Paradoxical Embolism is sometimes difficult since the thrombosis (1) may be confined to the calf veins and thus only detectable by venography; (2) may be localized in places other than in the leg veins and thus not detectable by leg venography; (3) may be not the cause but the consequence of arterial Embolism; or (4) may spontaneously dissolve, re-embolize, or recanalize.3 Due to these problems, a timely search for venous thrombosis is only rarely performed in patients with suspected Paradoxical Embolism, especially if they have no clinical symptoms of thrombosis. Several strategies are possible to overcome these obstacles. The first strategy is by improving noninvasive methods to visualize venous thrombosis in different locations, like magnetic resonance venography.4 Another strategy is by search for a clotting diathesis in patients with suspected Paradoxical Embolism. This indirect strategy is based on the assumption that hypercoagulability leads to a higher incidence of venous thrombosis and thus, in the presence of a PFO, might increase the possibility of Paradoxical Embolism. Hypercoagulability can be assessed by genetic testing for factor VG1691A mutation, prothrombinG20210A variant, and TT677 genotype of methylenetrahydrofolate reductase. The risk for venous thrombosis is increased 3- to 8-fold in heterozygous carriers of the factor VG1691A mutation, 3-fold in heterozygous carriers of the prothrombinG20210A variant, and …
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Why is venous thrombosis only rarely detected in patients with suspected Paradoxical Embolism
Thrombosis research, 2002Co-Authors: Claudia Stöllberger, Josef Finsterer, Jörg SlanyAbstract:Paradoxical Embolism should only be diagnosed if three conditions are present: arterial Embolism, a cardiac right-toleft shunt, and venous thrombosis. Whereas diagnosis of peripheral or cerebral arterial Embolism is facilitated by computed tomography, angiography, and Duplex sonography, and cardiac right-to-left shunts is reliably diagnosed by transesophageal contrast echocardiography or transcranial Doppler sonography, there are only a few studies with a small number of patients that evaluate the role of the venous system in patients with suspected Paradoxical Embolism (Table 1) [1–8]. Several authors do not even mention screening for venous thrombosis as useful investigation in patients with suspected Paradoxical Embolism [9,10]. From a diagnostic prerequisite for Paradoxical Embolism, venous thrombosis has been degraded to one of several ‘‘risk factors’’ [11–13 14]. Confirming or excluding venous thrombosis in patients with suspected Paradoxical Embolism, however, is of therapeutic relevance and not only a matter of academic interest, because
Jörg Slany - One of the best experts on this subject based on the ideXlab platform.
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Why is venous thrombosis only rarely detected in patients with suspected Paradoxical Embolism
Thrombosis research, 2002Co-Authors: Claudia Stöllberger, Josef Finsterer, Jörg SlanyAbstract:Paradoxical Embolism should only be diagnosed if three conditions are present: arterial Embolism, a cardiac right-toleft shunt, and venous thrombosis. Whereas diagnosis of peripheral or cerebral arterial Embolism is facilitated by computed tomography, angiography, and Duplex sonography, and cardiac right-to-left shunts is reliably diagnosed by transesophageal contrast echocardiography or transcranial Doppler sonography, there are only a few studies with a small number of patients that evaluate the role of the venous system in patients with suspected Paradoxical Embolism (Table 1) [1–8]. Several authors do not even mention screening for venous thrombosis as useful investigation in patients with suspected Paradoxical Embolism [9,10]. From a diagnostic prerequisite for Paradoxical Embolism, venous thrombosis has been degraded to one of several ‘‘risk factors’’ [11–13 14]. Confirming or excluding venous thrombosis in patients with suspected Paradoxical Embolism, however, is of therapeutic relevance and not only a matter of academic interest, because
-
The Prevalence of Deep Venous Thrombosis in Patients with Suspected Paradoxical Embolism
Annals of internal medicine, 1993Co-Authors: Claudia Stöllberger, Jörg Slany, Irmgard Schuster, Hermann Leitner, Walther-benedikt Winkler, Ronald KarnikAbstract:Objective: To determine the prevalence of venous thrombosis in patients with suspected Paradoxical Embolism. Design: Observational study. Patients: Two hundred sixty-four patients with clinically s...
