Page 18 - Journal of Structural Heart Disease Volume 5, Issue 5

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Original Scientific Article
alone. However, the clinical benefit of PFO closure for preventing recurrent stroke in older patients with stroke-related PFO has not been adequately evalu- ated. We believe that PFO closure in older patients might be considered if no causes of embolic source other than PFO and ASA are detected in patients with ESUS who undergo routine diagnostic assessment with additional TEE. Further study of larger numbers of ESUS patients is necessary to confirm our results.
Our study has several limitations. First, this was a single-center, retrospective study, which potentially introduces selection bias. Second, only a small num- ber of patients were analyzed. Third, undetected caus- es, such as subclinical paroxysmal atrial fibrillation, may have existed in the study population. All patients of this study underwent cardiac monitoring for ≥24 h with automated rhythm detection and none had any atrial high rate episodes up until discharge. This is insufficient monitoring, especially in older patients because the current recommendation is 2-4 weeks of ECG monitoring. Forth, we did not have follow up on the older patients who had PFO closure. It is un- known whether PFO closure of older ESUS patients related PFO is efficacy same as younger. However, we believe that our study population reflects a real world unselected population of patients with ESUS.
Conclusion
The embolic sources of ESUS were similar between younger and older patients except for aortic arch atherosclerotic plaques. However, the total number of embolic sources was significantly higher in older patients. Therefore, it is difficult to determine a dis- tinct single cause of stroke in older ESUS patients. Both younger patients and a small percentage of old- er patients have a risk of paradoxical embolism only, such as PFO or both PFO and ASA. Routine diagnostic assessment with additional TEE could help clarify the causes of ESUS.
Conflict of Interest
The authors have no conflict of interest relevant to this publication.
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Takafuji H. et al.
Embolic Sources in Young and Old ESUS Patients