HomeStrokeVol. 40, No. 7Methodological Issues in Right-to-Left Shunt Detection in CADASIL Patients Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBMethodological Issues in Right-to-Left Shunt Detection in CADASIL Patients Sara Mazzucco, MD, PhD Gian Paolo Anzola, MD Nicolò Rizzuto, MD Sara MazzuccoSara Mazzucco Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy Search for more papers by this author Gian Paolo AnzolaGian Paolo Anzola Service of Neurology, Sant’Orsola Hospital FBF, Brescia, Italy Search for more papers by this author Nicolò RizzutoNicolò Rizzuto Department of Neurological and Visual Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy Search for more papers by this author Originally published28 May 2009https://doi.org/10.1161/STROKEAHA.109.548982Stroke. 2009;40:e509Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 28, 2009: Previous Version 1 To the Editor:With regard to the article from Zigari et al,1 we would like to add some comments to the authors’ reply2 to our letter.3 The authors are very welcome to read our data that have indeed been published on an international, peer-reviewed journal.4 As to the second point of their reply, in our article we systematically referred to contrast enhanced transcranial Doppler diagnosis of right-to-left shunt instead of patent foramen ovale. We still believe that contrast enhanced transcranial Doppler is the most sensitive tool to detect right-to-left shunt, which is sustained by a patent foramen ovale in 95% of cases. Nevertheless, we think that if a relation is to be demonstrated between such a complex disease as CADASIL and interatrial septal abnormalities due to mutated Notch3-induced developmental disorders, these have at least to be documented anatomically. Otherwise, we could be left to suspect that 5% of the patients reported by Zicari et al1 had conditions other than a patent foramen ovale, such as a pulmonary arteriovenous malformation.DisclosuresNone.1 Zicari E, Tassi R, Stromillo ML, Pellegrini M, Bianchi S, Cevenini G, Gistri M, De Stefano N, Federico A, Dotti MT. Right-to-left shunt in CADASIL patients: prevalence and correlation with clinical and MRI findings. Stroke. 2008; 39: 2155–2157.LinkGoogle Scholar2 Zicari E, Tassi R, De Stefano N, Dotti MT. Response to letter by Mazzucco et al. Stroke. 2008; 39: e151.LinkGoogle Scholar3 Mazzucco S, Anzola GP, Rizzuto N. Right-to-left shunt in CADASIL patients: a comorbidity factor? Stroke. 2008; 39: e150.LinkGoogle Scholar4 Mazzucco S, Anzola GP, Ferrarini M, Taioli F, Olivato S, Burlina AP, Fabrizi GM, Rizzuto N. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy and right-to-left shunt: lack of evidence for an association in a prevalence study. Eur Neurol. 2008; 61: 46–49.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Chabriat H and Bousser M (2017) Cadasil, EMC - Neurologia, 10.1016/S1634-7072(17)85562-8, 17:3, (1-14), Online publication date: 1-Aug-2017. Paolucci M, Vincenzi C, Romoli M, Amico G, Ceccherini I, Lattanzi S, Bersano A, Longoni M, Sacco S, Vernieri F, Pascarella R, Valzania F and Zedde M (2021) The Genetic Landscape of Patent Foramen Ovale: A Systematic Review, Genes, 10.3390/genes12121953, 12:12, (1953) July 2009Vol 40, Issue 7 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.109.548982PMID: 19478217 Originally publishedMay 28, 2009 PDF download Advertisement