Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 143-154
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.143
Evaluation of right-to-left shunt on contrast-enhanced transcranial Doppler in patent foramen ovale-related cryptogenic stroke: Research based on imaging
Lei Xiao, Yan-Hong Yan, Ya-Fang Ding, Man Liu, Li-Juan Kong, Chun-Hong Hu, Pin-Jing Hui
Lei Xiao, Yan-Hong Yan, Ya-Fang Ding, Man Liu, Li-Juan Kong, Pin-Jing Hui, Stroke Center, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Chun-Hong Hu, Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Author contributions: Hui PJ and Xiao L designed the research study; Xiao L, Yan YH, Ding YF, Liu M and Kong LJ performed the research; Hu CH reviewed the images; Xiao L analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Supported by People’s Livelihood Science and Technology Project (Research on Application of Key Technologies) of Suzhou (No. SS202061) and Technical Cooperation Project of Soochow University (No. H211064).
Institutional review board statement: This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Soochow University (No. 2020-087).
Informed consent statement: Informed consent was obtained from all participants in this study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pin-Jing Hui, MD, PhD, Chief Physician, Professor, Stroke Center, the First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Suzhou 215006, Jiangsu Province, China. pinjing-hui@163.com
Received: August 22, 2021
Peer-review started: August 22, 2021
First decision: October 22, 2021
Revised: November 4, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: January 7, 2022
ARTICLE HIGHLIGHTS
Research perspectives

For future research, we will continue to study the mechanism of stroke in patent foramen ovale (PFO)-related cryptogenic stroke (CS) patients, and we plan to cooperate with other stroke centers to expand the range of sample selection and sample size. This will allow more accurate and clinically consistent research results.

Research conclusions

In this study, we propose that multiple territory infarctions may indicate permanent right-to-left shunt (RLS), while posterior circulation infarction may indicate latent RLS, which suggests that the distribution of infarct may provide clues for contrast-enhanced transcranial Doppler (c-TCD) screening for PFO. This study proposed a new method of analyzing the characteristics of infarction lesions by combining the type and grade of RLS detected on c-TCD.

Research results

The distribution of infarcts indicated a trend for the type of RLS. This observation could contribute to c-TCD screening for PFO. However, this study did have a potential selection bias, and the sample size was not large enough.

Research methods

This was a retrospective study. The normal group (non-CS patients) was selected for control study, and the CS patient group was divided into specific groups for intragroup and intergroup analyses. Patients in the CS patient group received both c-TCD and transesophageal echocardiography, which allowed us to observe patterns in the infarct lesions.

Research objectives

To find the association between the characteristics of infarction lesions and the type and grade of RLS in PFO-related CS patients. This information will provide a basis for future mechanism research of stroke in PFO-related CS patients.

Research motivation

We aimed to find an association between the characteristics of infarction lesions and the type and grade of RLS in PFO-related CS patients. We hypothesized that we could predict the type and grade of shunt detected during c-TCD examination by the characteristics of the infarction lesions, which would guide the effectiveness of c-TCD.

Research background

CS is relatively common in young people. RLS caused by PFO is an important risk factor for CS. Determining the characteristics of infarction lesions in PFO-related CS patients and the type and grade of RLS is of great value in the search for the etiology of CS.