{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:03:39Z","timestamp":1792101819731,"version":"4.4.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern","award":["Research grant diversity and excellence in clinica"],"award-info":[{"award-number":["Research grant diversity and excellence in clinica"]}]},{"name":"Kurt und Senta Hermann-Stiftung","award":["WNK-228"],"award-info":[{"award-number":["WNK-228"]}]},{"DOI":"10.13039\/100009068","name":"University of Bern","doi-asserted-by":"publisher","award":["UniBE Doc. Mobility grant"],"award-info":[{"award-number":["UniBE Doc. Mobility grant"]}],"id":[{"id":"10.13039\/100009068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Objectives:<\/jats:title>\n                    <jats:p>Cancer is associated with an increased risk of acute ischemic stroke (AIS) and venous thromboembolism. The role of a cardiac right-to-left shunt (RLS) as a surrogate parameter for paradoxical embolism in cancer-related strokes is uncertain. We sought to investigate the relationship between the presence of an RLS and cancer in AIS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included consecutive AIS patients hospitalized at our tertiary stroke center between January 2015 and December 2020 with available RLS status as detected on transesophageal echocardiography (TEE). Active cancers were retrospectively identified and the association with RLS was assessed with multivariable logistic regression and inverse probability of treatment weighting to minimize the ascertainment bias of having a TEE obtained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 2236 AIS patients included, 103 (4.6%) had active cancer, of whom 24 (23%) were diagnosed with RLS. An RLS was present in 774 out of the 2133 AIS patients without active cancer (36%). After adjustment and weighting, the absence of RLS was associated with active cancer (adjusted odds ratio (aOR) 2.29; 95% confidence interval (CI), 1.14\u20134.58). When analysis was restricted to patients younger than 60\u2009years of age or those with a high-risk RLS (Risk of Paradoxical Embolism Score\u2009\u2a7e\u20096), there was no association between RLS and cancer (aOR, 3.07; 95% CI, 0.79\u201311.88 and aOR, 0.56; 95% CI, 0.10\u20133.10, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>RLS was diagnosed less frequently in AIS patients with cancer than in cancer-free patients, suggesting that arterial sources may play a larger role in cancer-related strokes than paradoxical venous embolization. Future studies are needed to validate these findings and evaluate potential therapeutic implications, such as the general indication, or lack thereof, for patent foramen ovale (PFO) closure in this patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930241260589","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T00:40:27Z","timestamp":1717116027000},"page":"1020-1027","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence of right-to-left shunt in stroke patients with cancer"],"prefix":"10.1177","volume":"19","author":[{"given":"Fabienne","family":"Steinauer","sequence":"first","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5204-2016","authenticated-orcid":false,"given":"Philipp","family":"B\u00fccke","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Buffle","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"},{"name":"ARTORG Center, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8063-7882","authenticated-orcid":false,"given":"Mattia","family":"Branca","sequence":"additional","affiliation":[{"name":"CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayan","family":"G\u00f6cmen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-6128","authenticated-orcid":false,"given":"Babak B","family":"Navi","sequence":"additional","affiliation":[{"name":"Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava L","family":"Liberman","sequence":"additional","affiliation":[{"name":"Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, 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Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6839-7134","authenticated-orcid":false,"given":"Adnan","family":"Mujanovic","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kaesmacher","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"},{"name":"Neurology Department, University Hospital of Basel, University of Basel, Basel, 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