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To the Editor,In the recently published Controversies in Stroke on the best treatment of patients with patent foramen ovale (PFO) and stroke, much emphasis is put on the association of PFO with atrial septal aneurysm as a marker of increased stroke risk as compared with PFO alone, whereas PFO size seems to be a negligible variable.1–3 Data in support of this contention mainly come from a large, multicenter, French study4 where 581 patients were included and assessed with transesophageal echocardiography. PFO was sized by counting the bubbles appearing in the left atrium after antecubital injection of agitated saline and PFO size failed to represent a significant predictor of recurrence. However, as is clearly stated in the paper, the interrater disagreement for the amount of shunting was substantial (about 26%), and the technique employed in the French …

Transcranial Doppler: Cinderella in the Assessment of Patent Foramen Ovale in Stroke Patients