Percutaneous Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale

  title={Percutaneous Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale},
  author={Salvatore De Rosa and Horst Sievert and Jolanda Sabatino and Alberto Polimeni and Sabato Sorrentino and Ciro Indolfi},
  journal={Annals of Internal Medicine},
Patent foramen ovale (PFO) is a common finding that has been reported in 10% to 35% of persons (1, 2). The presence of PFO increases the risk for cardioembolic cerebrovascular accidents, such as stroke transient ischemic attacks (TIA), but most persons with PFOs remain asymptomatic and do not develop serious complications (2). Among young persons with a cryptogenic stroke, the prevalence of PFO is high (3), and approximately half have no apparent underlying causes (4). Because PFO may be a nest… 

Patent foramen ovale closure for secondary prevention of cryptogenic stroke

This manuscript will discuss medical, surgical, and transcatheter therapy for secondary prevention in patients with PFO and cryptogenic stroke, and summarize the data from observational studies, randomized controlled trials (RCTs), and meta-analysis of RCTs that have established the beneficial effect ofTranscatheter PFO closure in this patient population.

Patent foramen ovale closure or medical therapy for cryptogenic ischemic stroke: an updated meta-analysis of randomized controlled trials

PFO-C after cryptogenic ischemic stroke is safe and effective to reduce the risk of recurrent stroke and recurrent stroke + TIA, albeit with an increased risk for NOAF.

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

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.

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

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.

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

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.

Recurrent cerebrovascular events in patients after percutaneous closure of patent foramen ovale.

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

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.

Cryptogenic stroke and patent foramen ovale (abridged and translated version)

In patients with cryptogenic ischaemic stroke and patent foramen ovale, who reject a PFO closure, there is no evidence of superiority of oral anticoagulation over antiplatelet therapy, and secondary prevention should be performed with aspirin or clopidogrel.



Closure or medical therapy for cryptogenic stroke with patent foramen ovale.

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.

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

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.

Percutaneous closure of patent foramen ovale in cryptogenic embolism.

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

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.

Practice advisory: Recurrent stroke with patent foramen ovale (update of practice parameter)

Percutaneous PFO closure with the STARFlex device possibly does not provide a benefit in preventing stroke vs medical therapy alone and there is insufficient evidence to determine the efficacy of anticoagulation compared with antiplatelet therapy in preventing recurrent stroke.

Is patent foramen ovale a modifiable risk factor for stroke recurrence?

The concept of "PFO propensity," defined as the patient-specific probability of finding a PFO in a patient with CS on the basis of age and other risk factors, is introduced, and it is shown that this value is directly related to the probability that CS is PFO attributable.

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

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.

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

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.