ABSTRACT NUMBER: ESOC2026A2055 PATENT FORAMEN OVALE: AN IMPORTANT PLAYER IN ISCHAEMIC STROKES IN YOUNG ADULTS

Abstract Background and aims Patent foramen ovale (PFO) is an important structural finding, particularly in the context of cryptogenic cerebrovascular events. Despite its clinical relevance, real world incidence and demographic associations in the young stroke population remain incompletely characterised. This study aimed to assess the significance of PFO in young adults with ischaemic stroke. Methods A retrospective cohort study reviewed young adults (aged ≤55) with ischaemic strokes admitted to a hyperacute stroke unit from January 2024 to June 2025. Electronic patient records were analysed for demographics, NIHSS and PFO presence. Haemorrhages and patients with previous stroke history were excluded. Results PFO was reported in 19/142 young adults (13.4%). The median age of patients with PFO was 45 years (18-54), compared to 50 years (23-55) in those without PFO. Median NIHSS score was 3 in both groups. Sex distribution was similar between both groups (female PFO 31.6% vs non-PFO 30.1%, and male 68.4% vs 69.9%). Most patients’ PFOs (57.9%.) was graded III-V. Interventional closure was completed or planned in 13/19 patients (68.4%) emphasising the clinically significant shunt burden in this cohort. 4/19 (21.1%) of patients were not referred for closure. Conclusions There was no significant difference in stroke severity in patients with and without PFOs. The high proportion of grade III-V PFOs and closure referrals highlights the importance of systematic bubble studies for stroke prevention in young adults. A key limitation is that bubble contrast echocardiography was performed selectively in patients without an alterative stroke aetiology, which may have biased PFO detection. Conflict of interest Arunan Varatharsan: Nothing to disclose Duaa Ali Faruqi: nothing to disclose. Teswahen Bedawi: nothing to disclose. Aravinth Sivagnanaratnam: Nothing to disclose