Device Closure Versus Medical Therapy Alone for Patent Foramen Ovale in Patients With Cryptogenic Stroke

@article{Shah2018DeviceCV,
  title={Device Closure Versus Medical Therapy Alone for Patent Foramen Ovale in Patients With Cryptogenic Stroke},
  author={Rahman Shah and Mannu Nayyar and Ion S. Jovin and Abdul Rashid and Beatrix Ramos Bondy and Tai-Hwang M. Fan and Michael P Flaherty and Sunil V. Rao},
  journal={Annals of Internal Medicine},
  year={2018},
  volume={168},
  pages={335-342}
}
Stroke is a leading cause of death and long-term disability worldwide (1). Approximately one third of ischemic strokes have no identifiable cause and are classified as cryptogenic (1, 2). Many studies show that patent foramen ovale (PFO) is associated with cryptogenic stroke, particularly in young patients (3). Thus, transcatheter device closure of the defect may reduce the risk for recurrent stroke, and observational studies have suggested its efficacy (4, 5). However, the first 3 randomized… 

Correction: Device Closure Versus Medical Therapy Alone for Patent Foramen Ovale

  • Medicine
    Annals of Internal Medicine
  • 2018
There were errors in a recent meta-analysis that compared transcatheter patent foramen ovale (PFO) closure with medical therapy alone for prevention of recurrent stroke in patients with cryptogenic

Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis

TLDR
There is conclusive evidence that PFO closure reduces the recurrence of stroke or TIA in patients younger than 60 years of age with CS, and the comparison between anticoagulant and antiplatelet therapy shows no difference in terms of stroke recurrence, mortality and bleeding.

Closure versus Medical Therapy for Patent Foramen Ovale in Patients with Cryptogenic Stroke: An Updated Meta-Analysis of Randomized Controlled Trials.

Patent Foramen Ovale Closure—Addressing the Unmet Need for Reducing the Risk of Ischemic Stroke

TLDR
Emerging evidence from longer-term studies published in recent years has presented a clear case for the benefits of PFO closure in selected patients under the age of 60 years in terms of reducing risk of recurrent stroke.

Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized Trials

TLDR
It is suggested that transcatheter closure is indicated in patients with cryptogenic strokes and large PFO, even if with a significant risk increasing for new-onset atrial fibrillation.

The Fragility Index in Randomized Controlled Trials for Patent Foramen Ovale Closure in Cryptogenic Stroke.

  • M. TopcuogluE. Arsava
  • Medicine
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
  • 2019

Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: An Update

TLDR
Recent trials have shown that closure of PFO, especially if associated with an atrial septal aneurysm and/or a large interatrial shunt, may reduce the risk of recurrent stroke as compared to medical treatment.
...

References

SHOWING 1-10 OF 35 REFERENCES

Closure of patent foramen ovale versus medical therapy after cryptogenic stroke.

TLDR
There was no significant benefit associated with closure of a patent foramen ovale in adults who had had a cryptogenic ischemic stroke, however, closure was superior to medical therapy alone in the prespecified per-protocol and as-treated analyses, with a low rate of associated risks.

Long‐Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke

TLDR
Among adults who had had a cryptogenic ischemic stroke, closure of a PFO was associated with a lower rate of recurrent isChemic strokes than medical therapy alone during extended follow‐up.

Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: a network meta-analysis.

TLDR
PFO closure with AMP appears superior to medical therapy in preventing strokes in patients with cryptogenic embolism, but the effectiveness of PFO closure depends on the device used.

Percutaneous closure versus medical therapy alone for cryptogenic stroke patients with a patent foramen ovale: meta-analysis of randomized controlled trials.

TLDR
When compared with medical Therapy alone, PFO closure with medical therapy showed a trend toward a decreased hazard of combined events, although the absolute event reduction was small and the number needed to treat was high.

Device Closure of Patent Foramen Ovale After Stroke: Pooled Analysis of Completed Randomized Trials.

Transcatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli

TLDR
A systematic review was performed to synthesize the current state of knowledge on transcatheter closure of patent foramen ovale compared with medical therapy and identify the most appropriate therapy to prevent recurrent events in survivors of cryptogenic stroke or transient ischemic attack.

Critique of closure or medical therapy for cryptogenic stroke with patent foramen ovale: the hole truth?

TLDR
The CLOSURE I trial is the first randomized controlled trial to report the results of endovascular PFO closure in comparison with medical therapy and the “parachute” did not work as anticipated.

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

TLDR
Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to P FO closure combined with antiplatelet therapy than among those assign to anti platelet therapy alone.

Percutaneous closure of patent foramen ovale in cryptogenic embolism.

TLDR
Closure of a patent foramen ovale for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy.