{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:18:09Z","timestamp":1779963489834,"version":"3.53.1"},"reference-count":18,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:00:00Z","timestamp":1230768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:00:00Z","timestamp":1230768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis"],"published-print":{"date-parts":[[2009]]},"abstract":"<i>Background:<\/i> Right-to-left cardiac shunt (RLS) is considered a risk factor for stroke, especially in patients aged <55 years. We aimed to investigate the current management and prognosis in consecutive patients with RLS and otherwise cryptogenic cerebrovascular events. <i>Methods:<\/i> In total, 1,126 patients with cryptogenic stroke or TIA were included from 17 German neurology departments. During a mean follow-up of 28.4 months, we assessed current antithrombotic medication, percutaneous device closure (PDC) and recurrent cerebrovascular events in 899 patients (79.8%). Stroke recurrence was compared between 548 patients without RLS and 351 patients with RLS under various prevention regimens. <i>Results:<\/i> RLS was detected in 35.9% of cryptogenic cerebrovascular patients, but could not be evaluated as an independent predictor for recurrent stroke (adjusted HR 1.6, 95% CI: 0.9\u20132.7). In RLS-positive patients, the Kaplan-Meier estimate for stroke during the first year was 4.1% (95% CI: 1.9\u20136.3%) and 1.7% (95% CI: 0.9\u20132.4%) per year thereafter. At the last follow-up before recurrent stroke or end of study, 117 RLS-positive patients (33.3%) had received a PDC, 154 (43.9%) were receiving antiplatelets, 63 (17.9%) received anticoagulation, and 17 (4.8%) received none of the above. No association with recurrent stroke was found for the secondary preventive regime. <i>Conclusion:<\/i> Our multicenter hospital-based cohort study confirmed low recurrent event rates in RLS patients with otherwise cryptogenic stroke or TIA, as well as a great heterogeneity of current management. Despite the lack of scientific evidence, a substantial number of RLS-positive patients underwent PDC for secondary stroke prevention.<\/jats:p>","DOI":"10.1159\/000229553","type":"journal-article","created":{"date-parts":[[2009,7,24]],"date-time":"2009-07-24T11:20:14Z","timestamp":1248434414000},"page":"349-356","source":"Crossref","is-referenced-by-count":44,"title":["Current Management and Risk of Recurrent Stroke in Cerebrovascular Patients with Right-to-Left Cardiac Shunt"],"prefix":"10.1159","volume":"28","author":[{"given":"C.","family":"Weimar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.N.","family":"Holle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Benemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Schminke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.L.","family":"Haberl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.-C.","family":"Diener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Goertler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2009,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016%2FS0025-6196%2812%2960336-X"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.4065%2F74.9.862"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1212%2FWNL.55.8.1172"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1056%2FNEJMoa071422"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1161%2F01.CIR.0000017498.88393.44"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1159%2F000131083"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1161%2FCIRCULATIONAHA.107.709972"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1161%2F01.STR.24.1.35"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1056%2FNEJMoa011503"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1159%2F000016119"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1161%2F01.STR.0000135773.24116.18"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161%2FCIRCULATIONAHA.104.524371"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1161%2FCIRCULATIONAHA.107.757021"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1161%2FSTROKEAHA.108.521427"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1161%2F01.STR.31.10.2407"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016%2FS0140-6736%2806%2969087-9"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016%2Fj.jacc.2004.05.044"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016%2Fj.ijcard.2004.03.005"}],"container-title":["Cerebrovascular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/229553","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/229553","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T21:54:28Z","timestamp":1745445268000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000229553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2009,9,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000229553","archive":["Portico"],"relation":{},"ISSN":["1015-9770","1421-9786"],"issn-type":[{"value":"1015-9770","type":"print"},{"value":"1421-9786","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009]]}}}