Prevalence of right-left shunt in stroke patients with cancer.

Steinauer, Fabienne; Bücke, Philipp; Buffle, Eric; Branca, Mattia; Göcmen, Jayan; Navi, Babak Benjamin; Liberman, Ava; Boronylo, Anna; Clénin, Leander; Goeldlin, Martina Beatrice; Lippert, Julian; Volbers, Bastian; Meinel, Thomas; Seiffge, David J; Mujanovic, Adnan; Kaesmacher, Johannes; Fischer, Urs; Arnold, Marcel; Pabst, Thomas; Berger, Martin; ... (2024). Prevalence of right-left shunt in stroke patients with cancer. (In Press). International journal of stroke, 17474930241260589, p. 17474930241260589. SAGE 10.1177/17474930241260589

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Cancer is associated with an increased risk of acute ischemic stroke (AIS) and venous thromboembolism. The role of a cardiac right-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 a RLS and cancer in AIS patients.


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.


Of the 2236 AIS patients included, 103 (4.6%) had active cancer, of whom 24 (23%) were diagnosed with RLS. A 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], 1.14-4.58). When analysis was restricted to patients younger than 60 years or those with a high-risk RLS (Risk of Paradoxical Embolism Score ≥6), there was no association between RLS and cancer (aOR, 3.07; 95% CI, 0.79-11.88 and aOR, 0.56; 95% CI 0.10-3.10, respectively).


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 PFO closure in this patient population.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Bücke, Philipp Jonas, Buffle, Eric Jacques, Branca, Mattia, Clénin, Leander Caspar, Göldlin, Martina Béatrice, Lippert, Julian Peter, Volbers, Bastian, Meinel, Thomas Raphael, Seiffge, David Julian, Mujanović, Adnan, Kaesmacher, Johannes, Fischer, Urs Martin, Arnold, Marcel, Pabst, Thomas Niklaus, Berger, Martin Dave, Jung, Simon, Beyeler, Morin


600 Technology > 610 Medicine & health








Pubmed Import

Date Deposited:

03 Jun 2024 13:43

Last Modified:

14 Jun 2024 00:16

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Acute ischemic stroke Cancer Echocardiography Patent foramen ovale Right-left shunt Venous thromboembolism


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