Abstract Details

Title The Role of Intrapulmonary Shunt (IPS) in Embolic Stroke of Undetermined Source (ESUS)

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S34 - Stroke Risk Factors and Preventative Strategies (4:42 PM-4:54 PM)

Poster/Presentation
Number 007

Background ESUS is defined as ischemic stroke of undetermined etiology but whose underlying mechanism is likely embolic. There is a growing body of evidence which implicates IPS as a rare cause of ESUS. We conducted a descriptive analysis to describe the rates and characteristics of IPS and PFO in a population of adults with ESUS.

Objective To describe the incidences of intrapulmonary shunt (IPS) and patent foramen ovale (PFO) in a population of adults with embolic stroke of undetermined source (ESUS).

Design/Methods This was a retrospective chart review of 725 patients presenting to a single comprehensive stroke center with ESUS between April 2017 and April 2022. Clinical and demographic information was collected, including age, sex, prolonged cardiac monitoring, transesophageal echocardiography (TEE) findings, and incidence of stroke recurrence within three years of initial admission. Differences in age and stroke recurrence between patients with IPS, PFO, or neither were evaluated using univariable linear regressions at α<0.05.

Results Patients who had evidence of atrial fibrillation on prolonged cardiac monitoring were excluded (n=112; 15.4%). Of the remaining 613 patients who received a diagnosis of ESUS, 102 (16.6%) were found to have a PFO and 30 (5%) were found to have an IPS on TEE. Patients with an IPS were younger than those without TEE abnormalities (57 years vs. 62 years; p<0.05), and were more likely to have a recurrent stroke within three years of their initial hospital admission (23.7% vs. 10.1%; p=0.03). IPS patients were similarly more likely to have a recurrent stroke than PFO patients (26.7% vs. 8.82%; p=0.02), but did not show a significant difference in age (p=0.94).

Conclusions IPS is an uncommon but potentially important TEE finding that may contribute to the pathogenesis of ESUS. Further investigation is needed to determine IPS as an independent risk factor for ESUS.

Authors/Disclosures
Jordan Houser PRESENTER	Ms. Houser has nothing to disclose.
Riana Schleicher	Ms. Schleicher has nothing to disclose.
Bichum Ouyang	No disclosure on file
	No disclosure on file
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.