Observational studyFrontiers in neurology2026
Right-to-left shunt is associated with reduced cerebral vascular reactivity in migraine patients with aura.
Observational study in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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Abstract
Objective: To investigate whether right-to-left shunt (RLS) associated with patent foramen ovale (PFO) is associated with altered cerebrovascular reactivity (CVR) in migraine patients with aura. Methods: This cross-sectional observational study enrolled migraine patients with aura who attended the outpatient clinic of Anhui No. 2 Provincial People's Hospital between December 2022 and September 2025. All patients underwent contrast-enhanced transcranial Doppler (c-TCD) examination, confirmed by contrast transthoracic echocardiography (c-TTE), to detect RLS and determine PFO status. PFO-negative patients served as the internal control group. RLS was graded (0-3) based on the number of microembolic signals (MES), and patients were further classified as having either latent RLS (microbubbles appearing only after Valsalva maneuver) or persistent RLS (microbubbles appearing at rest). Cerebrovascular reactivity was indirectly assessed by measuring the breath-holding index (BHI) via transcranial Doppler. BHI differences were compared between PFO-positive (+) and PFO-negative (-) groups, between latent and persistent PFO groups, and across different RLS grade groups. Results: Compared with the PFO (-) group, the PFO (+) group exhibited significantly reduced BHI values in the bilateral middle cerebral arteries (MCAs) and bilateral posterior cerebral arteries (PCAs; all Conclusion: RLS associated with PFO is associated with reduced CVR in migraine patients with aura, with more pronounced reductions in cases of large shunts and persistent shunt types.
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