ABSTRACT NUMBER: ESOC2026A2196 NEUROIMAGING AND CLINICAL PHENOTYPE OF PATENT FORAMEN OVALE–RELATED ISCHEMIC STROKE: A REAL-WORLD COHORT STUDY

Abstract Background and aims Patent foramen ovale (PFO) is frequently identified in young patients with ischemic stroke of undetermined etiology despite a comprehensive etiologic workup. However, whether PFO-related stroke presents a distinctive clinical and neuroimaging phenotype remains insufficiently characterized, particularly in real-world cohorts. Methods We conducted a prospective cohort study including consecutive patients with ischemic stroke and confirmed PFO. Clinical variables, RoPE score, stroke severity (NIHSS), modified Rankin Scale (mRS) at 90 days, and neuroimaging characteristics were analyzed. Patterns were classified according to vascular territory, cortical involvement, and presence of multiple ischemic lesions. Continuous variables were compared using non-parametric tests, and categorical variables using chi-square or Fisher’s exact test, as appropriate.Comparisons were performed according to RoPE score. Results A total of 123 patients were included (median age 44 years, IQR 35–52; 55% women). Most patients presented with mild neurological deficits (median NIHSS 4, IQR 4–10). Cortical involvement was observed in 43% of cases, and 8% presented with multiple ischemic lesions. Posterior circulation strokes accounted for 26% of cases. At least 38% of patients had moderate-to-large infarct size. A favorable functional outcome (mRS 0–2) at 90 days was observed in 75% of patients. Patients with high RoPE scores showed a significantly higher prevalence of cortical and multifocal infarcts compared with lower scores (p<0.05). Conclusions Ischemic stroke associated with PFO presents frequent cortical involvement and generally mild-to-moderate clinical severity. However, a substantial proportion of patients experienced moderate-to-large infarcts, contrasting with previous reports. These findings support the concept of PFO-related stroke may have different patterns. Conflict of interest Nothing to disclose