Frequency of atrial septal aneurysm in patients with recent stroke: Preliminary results from a multicenter study

Background: The role of atrial septal aneurysm (ASA) as a risk factor for c erebral ischemia of unknown etiology is controversial. Recent studies have found an association between ASA and focal ischemic events, while results f rom other studies suggest a low incidence of embolism in patients with ASA. Hypothesis: The present study was designed to evaluate the frequency of ASA , a minor cardioembolic source, in patients with a recent stroke presenting with normal carotid arteries. Methods: In all, 394 patients with cerebral ischemic stroke were referred t o our institutions. Patients underwent transthracic and transesophageal ech ocardiography and carotid artery ultrasound examination. The study populati on included 215 patients without significant arterial disease. Frequency an d morphologic characteristics of ASA were evaluated. Results: Transthoracic examination showed ASA in 39 patients (18%), while t ransesophageal echocardiography showed ASA in 61 patients (28%). A patent f oramen ovale was found in 47 patients (21.8%) and was associated with ASA i n 40 patients (65.5%). We observed an increased thickness of the aneurysmat ic wall (3.80 +/- 1.7 mm) in all patients with ASA. Conclusions: The present study confirms the relationship between ASA and st roke in patients with normal carotid arteries. The most common abnormality associated with ASA was patent foramen ovale. We suggest that patients who have a stroke in the absence of significant carotid disease undergo transes ophageal echocardiography to identify possible underlying septal abnormalit ies.