Interview with Professor Haiqing Song: Diagnosis strategies for the etiology of cardiogenic stroke from the latest SCAI PFO management guidelines

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In recent years, cardiogenic stroke has become more and more common, and the onset is often more acute and serious, which not only seriously affects the quality of life of patients, but also significantly reduces the survival time of stroke patients, bringing heavy burden
to families and society.
On August 5-7, 2022, the 8th Annual Conference of the Chinese Stroke Society and the Tiantan International Conference on Cerebrovascular Disease were held, during which Yimaitong interviewed Professor Song Haiqing from Xuanwu Hospital of Capital Medical University on the topic of "Talking about the Etiological Diagnosis Strategy of Cardiogenic Stroke from the Latest PFO Management Guidelines of SCAI".

Medical Pulse: What are the clinical manifestations of cardiogenic stroke compared to other types of stroke, and under what circumstances do we need to consider the possibility of cardiogenic stroke?

Professor Song Haiqing: In recent years, the prevention and treatment of stroke has undergone great changes through everyone's efforts, and the prevention and treatment of atherosclerosis-related risk factors, such as controlling hypertension, antiplatelet and lipid-lowering therapy, etc.
, has become better and better.

From a clinical point of view, cardiogenic stroke has some characteristics: (1) it tends to have a more acute onset, a more severe condition, and is prone to early bleeding transformation of infarction; (2) Imaging features: lesions are sometimes multiple, and often have foci
in the cross-vascular blood supply basin.
These signs are some important bases for clinicians to identify cardiogenic stroke early, and some auxiliary tests are needed, such as screening for atrial fibrillation, ECG or long-term ECG; When a structural defect in the heart is suspected, some cardiac imaging tests
are done.

Yimaitong: Could you briefly introduce the connection between cardiogenic stroke and PFO, and how should cardiogenic stroke patients with PFO be diagnosed clinically?

Professor Song Haiqing: For cardiogenic stroke in the past, more attention was paid to non-valvular atrial fibrillation, PFO is also a kind of cardiogenic stroke, in recent years, PFO (patent foramen ovale) and stroke association has received more and more attention
.
There are two main reasons: on the one hand, from the current clinical evidence, there is more evidence for high-risk stroke-related PFO closure surgery, and more and more cardiologists carry out this operation; On the other hand, the detection and screening technology for right-to-left shunts is becoming more and more mature, such as the foaming experiment
of TCD.
Therefore, neurology, vascular ultrasound and cardiology are paying more and more attention to this problem
.
There is also the characteristics of PFO itself, about 1/4 of adults have this defect, and some PFO is associated with migraine and stroke, these patients often first go to the neurology department, and have become a very important part
of cardiogenic stroke screening.

Yimaitong: How should cardiogenic stroke patients with PFO be treated clinically?

Professor Song Haiqing: The most important thing is to first clarify the diagnosis, whether ischemic stroke is related to cardiac stroke, and whether the cause can be determined as PFO? PFOs that cause stroke are high-risk PFOs and require active intervention to prevent stroke recurrence
.
For high-risk PFO, according to the current clinical evidence, it is recommended to have the conditions for closure, combined with drug therapy; For low-risk PFOs or difficulties in closing, drugs or other treatments
are needed.