Impact of a multidisciplinary group on management of patent foramen ovale in cryptogenic stroke and outcome measures: A retrospective study

Patent foramen ovale (PFO) is a common cardiac abnormality present in roughly 25% of the adult population. Although typically benign, patients with a PFO account for 50% of the population of cryptogenic stroke, an ischemic stroke with an unknown cause. Guidelines suggest closure in patients with a cryptogenic stroke found to have a PFO; however, it is unclear whether medical treatment should be given to all patients, regardless of PFO closure, and data is limited on the treatment outcomes. This retrospective chart analysis of 80 patients with a cryptogenic stroke found to have a PFO will investigate the criteria a multidisciplinary team used to determine whether patients should undergo PFO closure, receive medical therapy, or receive both. Additionally, it will investigate stroke recurrence, the percentage of patients with postprocedural complications, and the percentage of patients where the cause of the stroke was determined later. There is currently limited data on treatment outcomes and stroke recurrence in this cohort of patients, so this study will provide valuable knowledge that will help clinicians make more informed decisions on how to treat patients with cryptogenic stroke found to have a PFO

Pennsylvania comprehensive stroke center collaborative: Statement on the recently updated IV rt-PA prescriber information for acute ischemic stroke.

OBJECTIVE: Recently, the FDA guidelines regarding the eligibility of patients with acute ischemic stroke to receive IV rt-PA have been modified and are not in complete accord with the latest AHA/ASA guidelines. The resultant differences may result in discrepancies in patient selection for intravenous thrombolysis. METHODS: Several comprehensive stroke centers in the state of Pennsylvania have undertaken a collaborative effort to clarify and unify our own recommendations regarding how to reconcile these different guidelines. RESULTS: Seizure at onset of stroke, small previous strokes that are subacute or chronic, multilobar infarct involving more than one third of the middle cerebral artery territory on CT scan, hypoglycemia, minor or rapidly improving symptoms should not be considered as contraindications for intravenous thrombolysis. It is recommended to follow the AHA/ASA guidelines regarding blood pressure management and bleeding diathesis. Patients receiving factor Xa inhibitors and direct thrombin inhibitors within the preceding 48h should be excluded from receiving IV rt-PA. CT angiography is effective in identifying candidates for endovascular therapy. Consultation with and/or transfer to a comprehensive stroke center should be an option where indicated. Patients should receive IV rt-PA up to 4.5h after the onset of stroke. CONCLUSIONS: The process of identifying patients who will benefit the most from IV rt-PA is still evolving. Considering the rapidity with which patients need to be evaluated and treated, it remains imperative that systems of care adopt protocols to quickly gather the necessary data and have access to expert consultation as necessary to facilitate best practices