Paradoksalna embolija kao uzrok moždanoga udara

master's thesis

• Title (english): Paradoxical embolisation as a cause od stroke
• Author: Sara Sakač
• Mentor: Branko Malojčić (mentor)
• Committee member: Zdravka Poljaković-Skurić (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Branko Malojčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Paradoksalna embolija nastaje kada tromb iz venskog vaskularnog sustava prolazi kroz intrakardijalni defekt ili kroz plućni arteriovenski pretok i ulazi u sistemsku cirkulaciju. Ovisno o mjestu u koje embolizira, može dovesti do nastanka moždanog udara (MU), periferne arterijske okluzije ili ishemije visceralnih organa. Otvoreni foramen ovale (PFO), ostatak fetalne cirkulacije prisutan u oko 25% opće populacije, najčešći je uzrok desno-lijevog pretoka u odraslih. Povezuje se s MU nepoznatog uzroka (kriptogeni, KMU) koji čini oko 25-40% svih ishemijskih MU-a. PFO se javlja u 40-56% pacijenata <55 godina s KMU-om ili tranzitornom ishemijskom atakom (TIA). Međutim, oko jedne trećine PFO-a slučajan su nalaz. Mogućnost paradoksalne embolije trebala bi se razmatrati kod svih pacijenata s arterijskim embolusom neidentificiranog izvora. Dijagnoza se ponekad teško postavlja i tada je potreban multidisciplinarni pristup kako bi se isključili ostali potencijalni uzroci iz diferencijalne dijagnoze. Opcije sekundarne prevencije MU-a uključuju modifikaciju čimbenika rizika, antitrombocitnu ili antikoagulacijsku terapiju i endovaskularno ili kirurško zatvaranje PFO-a. Izbor ovisi o riziku za ponavljanje MU-a, omjeru koristi i rizika između antitrombotičke terapije i kirurškog zahvata kao i o mogućim komplikacijama pojedinog pristupa. Kako bi se odredilo je li endovaskularno zatvaranje PFO-a indicirano, potrebno je odrediti uzročnu povezanost između PFO-a i KMU-a. Pacijenti s visokim rizikom recidiva MU-a kojem se može pripisati povezanost s PFO-om, najvjerojatnije će imati korist od zatvaranja PFO-a.

Abstract (english)

Paradoxical embolism occurs when a venus-source thrombus passes through an intracardiac defect or pulmonary shunt into the systemic circulation. Depending on the site of the resultant embolization, it can cause stroke, peripheral arterial occlusion or visceral organ ischemia. A patent foramen ovale (PFO), a common remnant of fetal circulation present in about 25% of the general population, is the most frequent cause of R-L shunt in adults. It has been associated with stroke of unclear cause (cryptogenic, CS) that accounts for approximately 25–40% of all ishemic strokes. PFO occurs in 40–56% of patients <55 years old with CS or transient ischemic attack (TIA). However, approximately one third of discovered PFOs represent incidental findings. The possibility of paradoxical embolism should be considered in all patients with an arterial embolus of non-identifiable source. The diagnosis can be difficult to establish and multidisciplinary approach is usually necessary to exclude other possibilities from the differential diagnosis. Treatment options for secondary stroke prevention include risk factor modification, antithrombotic or anticoagulant therapy and endovascular or surgical closure of PFO. The choice is dependent on the risk of stroke recurrence, the benefit/risk ratio between antithrombotic therapy and surgery, as well as the potential complications of each intervention. To decide if endovascular closure is indicated, it is essential to determine the degree of causal relationship between the PFO and the CS. Patients with high “PFO-attributable recurrence risk“ are most likely to benefit from percutaneous PFO closure.

• Keywords: paradoksalna embolija; kriptogeni moždani udar; otvoreni foramen ovale
• Keywords (english): paradoxical embolism; cryptogenic stroke; patent foramen ovale
• Language: croatian
• URN:NBN: urn:nbn:hr:105:106661
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-02-10 13:01:46