How important is early treatment of a mild heart attack?
Cerebrovascular accidents (CVA) are the most important cause of disability in adults and one of the most important causes of death worldwide.
They cause serious physical, mental, social and economic impacts not only on surviving patients, but also on their families.
While in most countries of the world, CVAs are clearly fewer than myocardial infarctions, in Greece this number is similar.
Specifically, in our country it is estimated that 30 to 35 thousand new CVAs occur every year.
Although the treatment of acute myocardial infarction has made leaps and bounds, resulting in a dramatic reduction in the corresponding mortality and morbidity, the treatment of CVA has not achieved the same.
Modern data demonstrate that immediate pharmacological and/or mechanical (thrombectomy) restoration of blood flow in the cerebral artery responsible for the stroke – with protocols similar to those for myocardial infarction – contributes dramatically to improving the prognosis of patients with stroke, significantly reducing the severity of disability and mortality.
The role of the cardiologist is unique in identifying the cause of stroke.
In a significant 15% – 35% of cases, it is not possible to determine the underlying etiological mechanism and the strokes are called cryptogenic.
It is worth noting that the category of cryptogenic strokes also includes those in which inadequate testing has been performed or more than one possible cause of stroke has been found.
In recent years, the landscape has become clearer in the management of patients with cryptogenic stroke and the presence of a patent foramen ovale (PFO). A PFO is essentially a very small atrial septal defect, that is, a small hole between the left and right atria that is present in 20-25% of the population.
In general, there is absolutely no reason or even discussion to close an asymptomatic PFO.
However, there are cases in which the PFO may be responsible for cryptogenic stroke through paradoxical thromboembolism where a clot that forms in the venous system (e.g. after a leg injury, venous stasis) passes through the PFO from the right to the left atrium and occludes an artery in the brain, causing a stroke.
Advocating in this direction are anatomical variations such as aneurysm of the atrial septum, the Eustachian valve and the Chiari network.
The diagnosis is practically made by performing a transesophageal echocardiogram, while clinical evidence is necessary at the onset of neurological symptoms, since paradoxical embolism can be caused by coughing, laughing, sneezing, deep inhalation or release during the Valsalva test.
The results of recent international prospective multicenter studies suggest percutaneous closure of the PFO by implantation of these devices – umbrellas.
This invasive procedure is quite simple, is performed under the guidance of a transesophageal echocardiogram and requires a single day’s hospitalization. The result is a significant reduction in stroke recurrences, which can sometimes be fatal.
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