Supplementary Material for: Age-related Variations in Patterns of Patent Foramen Ovale-Stroke versus Other Cryptogenic Stroke

Introduction: Patent Foramen Ovale (PFO)-stroke, a form of cryptogenic stroke, has certain identifying clinical and imaging features. However, data describing this stroke type remains inconsistent. This study examined the potential variations in PFO-stroke features, depending on age.

Methods: From a hospital registry, cryptogenic stroke patients were retrospectively selected, and PFO-strokes identified by the presence of >10 microembolic signals (MES) on transcranial doppler (TCD) saline agitation test. Cryptogenic strokes were grouped according to age (<70 as young, >70 as elderly). Clinical and imaging variables of PFO-strokes and non-PFO strokes were compared, with and without age considered.

Results: Of the 462 cryptogenic patients, 30.5% (141/462) were PFO-strokes, while majority (321/462) had no PFO. When cryptogenic strokes were analyzed by age, the significant difference was noted in the lesion number, pattern, and side. A single (72.8% vs 57.9%, p=0.020) and a small single lesion (51.1% vs 35.5%, p=0.039) were frequently seen in the younger PFO-strokes than the non-PFO counterpart, while mixed territory lesions identified the elderly PFO-strokes (30.6% vs 8.9%, p=0.001). A multivariate logistic regression analysis of PFO-strokes further showed that age was independently associated with lesion side (OR 1.12 (1.05-1.20), p<0.001) and lesion number (OR 1.06 (1.02-1.10), p=0.005).

Conclusions: Incorporating age-specific imaging criteria in the identification of PFO-strokes may be of additional value. Further, PFO may remain contributory to the stroke risk in the elderly, in association with vascular risk factors.

引言：卵圆孔未闭（Patent Foramen Ovale, PFO）相关性卒中作为隐源性卒中的一类亚型，具备特定的临床与影像学识别特征，但当前针对该卒中类型的相关描述仍存在不一致性。本研究旨在探究不同年龄分层下PFO相关性卒中的特征差异。
方法：本研究从某医院卒中登记库中回顾性筛选隐源性卒中患者，通过经颅多普勒（transcranial doppler, TCD）盐水激发试验检出微栓子信号（microembolic signals, MES）≥10个者，确诊为PFO相关性卒中。按照年龄将所有入组的隐源性卒中患者分为两组：年龄<70岁者为青年组，年龄>70岁者为老年组。分别在考虑年龄分层与不考虑年龄分层的两种情境下，对比PFO相关性卒中与非PFO相关性卒中的临床及影像学变量差异。
结果：本研究共纳入462例隐源性卒中患者，其中30.5%（141/462）为PFO相关性卒中，其余多数（321/462）未合并PFO。按年龄分层分析隐源性卒中患者后发现，病灶数量、分布模式及侧别存在显著组间差异。青年PFO相关性卒中患者更易出现单发灶（72.8% vs 57.9%，p=0.020）及单发小病灶（51.1% vs 35.5%，p=0.039）；而老年PFO相关性卒中患者则更常出现混合供血区病灶（30.6% vs 8.9%，p=0.001）。针对PFO相关性卒中患者的多因素logistic回归分析进一步显示，年龄与病灶侧别（比值比OR=1.12，95%置信区间CI：1.05~1.20，p<0.001）及病灶数量（OR=1.06，95%CI：1.02~1.10，p=0.005）均存在独立相关性。
结论：在PFO相关性卒中的识别流程中纳入基于年龄分层的影像学标准，可进一步提升其诊断价值。此外，在合并血管危险因素的老年人群中，PFO仍可能是卒中发生的潜在危险因素。