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A model of multi-disciplinary approach to the diagnosis and treatment of young patients with cryptogenic stroke and patent foramen ovale

Published online by Cambridge University Press:  21 February 2012

Sara Mazzucco ,
Paolo Bovi ,
Monica Carletti ,
Giampaolo Tomelleri ,
Giorgio Golia ,
Chiara Stegagno ,
Andrea Variola ,
Maurizio Anselmi ,
Daniele Nicolis  and
Silvia Olivato
...Show all authors
Sara Mazzucco*
Affiliation:
Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, Verona, Italy
Paolo Bovi
Affiliation:
Department of Neurosciences, Stroke Unit, Verona, Italy
Monica Carletti
Affiliation:
Division of Cardiology, Department of Medicine, University Hospital of Verona, Verona, Italy
Giampaolo Tomelleri
Affiliation:
Department of Neurosciences, Stroke Unit, Verona, Italy
Giorgio Golia
Affiliation:
Division of Cardiology, Department of Medicine, University Hospital of Verona, Verona, Italy
Chiara Stegagno
Affiliation:
Division of Neurology, Rovereto Hospital, Trento, Italy
Andrea Variola
Affiliation:
Division of Cardiology, Department of Medicine, University Hospital of Verona, Verona, Italy
Maurizio Anselmi
Affiliation:
Cardiology Unit, San Bonifacio Hospital, Verona, Italy
Daniele Nicolis
Affiliation:
Division of Cardiology, Department of Medicine, University Hospital of Verona, Verona, Italy
Silvia Olivato
Affiliation:
Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, Verona, Italy
Gian Paolo Anzola
Affiliation:
Service of Neurology, S. Orsola Hospital, Fondazione Poliambulanza, Brescia, Italy
Flavio Ribichini
Affiliation:
Division of Cardiology, Department of Medicine, University Hospital of Verona, Verona, Italy
*
Correspondence to: Dr S. Mazzucco, MD, PhD, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Policlinico “G.B. Rossi”, Piazzale L.A. Scuro 10, 37134 Verona, Italy. Tel: +39 045 812 4285; Fax: +39 045 802 7492; E-mail: sara.mazzucco@univr.it
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Abstract

Background

Treatment of patent foramen ovale in young patients with stroke is not supported by robust scientific evidence. In clinical practice, a pragmatic approach is needed to guide such therapeutic decisions. This study aims at standardising the diagnostic pathway for stroke patients younger than 55 years of age with a patent foramen ovale; elaborating a therapeutic algorithm; discussing every case in regular interdisciplinary counselling meeting; and setting up a follow-up schedule to assess clinical outcomes.

Methods

This is a cohort study on the effect of a standardised treatment of stroke patients with a patent foramen ovale. The primary endpoints include occurrence of recurrent ischaemic events, major bleeding, and device-related complications. The secondary endpoints include drug- or procedure-related side effects, persistence of right-to-left shunt, and persistent cardiac arrhythmia of new onset.

Results

A total of 103 patients have been enrolled. In all, 51 patients underwent percutaneous atrial septal repair; of these, one had minor post-procedural bleeding. At 12 months, 25% of this group of patients showed a latent I grade shunt, one patient a latent II degree shunt, and none had a persistent shunt. The remaining 52 patients were addressed to medical therapy; one of them experienced stroke recurrences while on medical therapy.

Conclusions

This model of implementation of available evidence to clinical practice via a group-based, multi-disciplinary counselling provides a shared and coherent decision pathway and yielded a very low rate of recurrent events and therapy-related complications. This approach could be replicated in specific protocols for other complex or neglected clinical problems.

Keywords

Stroke in the youngpercutaneous atrial septal repairmulti-disciplinary counselling
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 3 , June 2012 , pp. 327 - 334
Copyright
Copyright © Cambridge University Press 2012

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Footnotes

†

Other members of the VEROSTROKE group: 1Federico Beltrame MD, 1Adolfo Benini MD, 1Paolo Benussi MD, 2Giuseppe Moretto, 3Antonio Fiaschi MD, 1Isabella Loschiavo MD, 4Gionata Molinari MD, 4Gabriele Pesarini MD, 4Antonia Prioli MD, 4Laura Rossi MD, and 4Corrado Vassanelli MD. From: 1Department of Medicine, Cardiology Unit; University Hospital of Verona, Verona, Italy; 2Department of Neurosciences, Neurology Unit, University Hospital of Verona, Verona, Italy; 3Department of Neurological and Visual Sciences, Section of Clinical Neurology, University Hospital of Verona, Verona, Italy; 4Department of Medicine, Division of Cardiology, University Hospital of Verona, Verona, Italy.

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