Patent foramen ovale closure or medical therapy for secondary prevention of cryptogenic stroke

@article{Ma2018PatentFO,
  title={Patent foramen ovale closure or medical therapy for secondary prevention of cryptogenic stroke},
  author={Yingxu Ma and Dongping Li and Fan Bai and Fen Qin and Jiayi Li and Yixi Li and Na Liu and Hui Xie and Shenghua Zhou and Qiming Liu},
  journal={Medicine},
  year={2018},
  volume={97}
}
Background: It was under debate whether cryptogenic stroke patients benefited from patent foramen ovale (PFO) closure. We sought to determine secondary prevention strategy in these patients. Methods: Scientific databases were searched for randomized controlled trials enrolling cryptogenic stroke patients with PFO who underwent PFO closure or medical therapy. The random-effect model was used to analyze the outcomes. Results: We identified 6 trials enrolling 3630 participants in this meta… 
3 Citations
Meta-analysis of patent foramen ovale closure versus medical therapy for prevention of recurrent ischemic neurological events
TLDR
With the addition of anticoagulants, the benefit of PFO closure decreased gradually, and patient groups that adopt individualized medical therapy strategies may benefit more.
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
TLDR
These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
Sekundärprävention nach ischämischem Schlaganfall
TLDR
Interventionell ist der Nutzen der Karotisendarteriektomie sowie — in speziellen Patientengruppen — der Stent-Einlage in die KarotIS als auch der interventionelle Verschluss des offenen Foramen ovale gut belegt.

References

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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.
Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke.
Closure or medical therapy for cryptogenic stroke with patent foramen ovale.
TLDR
In patients with cryptogenic stroke or TIA who had a patent foramen ovale, closure with a device did not offer a greater benefit than medical therapy alone for the prevention of recurrent stroke orTIA.
Device closure of patent foramen ovale versus medical therapy in cryptogenic stroke: a systematic review and meta-analysis.
Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale: Patent Foramen Ovale in Cryptogenic Stroke Study
TLDR
On medical therapy, the presence of PFO in stroke patients did not increase the chance of adverse events regardless of P FO size or the presenceof atrial septal aneurysm.
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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.
Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke
TLDR
Among patients with a PFO who had a cryptogenic stroke, the risk of subsequent ischemic stroke was lower among those assign to PFO closure combined with antiplatelet therapy than among those assigned to anti platelet therapy alone; however, PFOclosure was associated with higher rates of device complications and atrial fibrillation.
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.
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