Work

Prevalence of patent foramen ovale in solid organ cancer patients with embolic stroke – A case series

Year: 2026

Type: article

Abstract: BACKGROUND: Cancer-associated stroke has become increasingly recognized as a subcategory of embolic stroke of undetermined source (ESUS). Paradoxical embolism through a patent foramen ovale (PFO) is frequently cited as a common stroke mechanism in this population, but its prevalence in an ESUS cohort with newly diagnosed cancer is unknown. OBJECTIVE: To determine the prevalence of PFO in patients with solid organ malignancy and ESUS. METHODS: We searched the Stanford Research Repository for adults with solid organ malignancies who suffered a stroke secondary to an anterior circulation large vessel occlusion within 1 year after their cancer diagnosis. Only subjects who had an echocardiogram with bubble study were included. Chart extraction was completed for clinical/radiographic information. We used descriptive statistics to summarize the data. RESULTS: Fifty-five patients were included. Median time from cancer diagnosis to stroke was 65 days (IQR 11-182). The most common primary cancer site was lung (25.5%); 43.6% had metastases; 21/55 (38.2%) transitioned to comfort care during hospitalization. The prevalence of PFO was 20% (11/55). Paradoxical embolism was identified as a likely mechanism of stroke in 5/11 (45%) patients with PFO based on co-occurring venous thromboembolism (VTE). In 4/5 patients, VTE was asymptomatic and diagnosed based on screening studies at presentation. CONCLUSION: The prevalence of PFO among cancer patients with ESUS was 20%, and there was a high (45%) rate of co-occurring VTE. Given the high rates of asymptomatic detection of VTE identified based on screening ultrasounds, these results could support screening for VTE in this population.

Source: Journal of Stroke and Cerebrovascular Diseases

DOI: 10.1016/j.jstrokecerebrovasdis.2026.108597