Odyssey of Patent Foramen Ovale: Closure in Cryptogenic Stroke: The Canary in the Coal Mine of Clinical Trials?

Vemulapalli, Sreekanth; Patel, Manesh R.

doi:10.1161/jaha.118.009558

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…However, the trial design may have contributed to the conclusion, as event rates were low in this young patient population, thereby necessitating longer follow-up than the studies used. Further, patients with lacunar infarcts – whose strokes were less likely to have been embolic – were included [36]. Recent studies, however, with more rigorous patient selection, have shown a benefit of closure in reducing recurrent stroke risk (Table 2).…”

Section: Patent Foramen Ovale Closurementioning

confidence: 99%

Secondary stroke prevention in patients with patent foramen ovale

Rhoades¹,

Tzeng²,

Ruggiero

2021

Current Opinion in Hematology

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Purpose of review Although a patent foramen ovale (PFO) is an established risk factor for cryptogenic ischemic stroke, strategies for secondary prevention remain controversial. Increasing evidence over the past decade from well designed clinical trials supports transcatheter PFO closure for selected patients whose stroke was likely attributable to the PFO. However, patient selection using imaging findings, clinical scoring systems, and in some cases, thrombophilia testing, is crucial for determining patients most likely to benefit from closure, anticoagulation, or antiplatelet therapy. Recent findings Recent studies have found that patients with a high Risk of Paradoxical Embolism (RoPE) score and those with a thrombophilia benefit more from closure than medical therapy (including antiplatelet or anticoagulant therapy) alone. Meta-analyses have demonstrated an increased short-term risk of atrial fibrillation in closure patients, and that residual shunt after closure predicts stroke recurrence. Last, recent data have been inconclusive as to whether patients receiving medical therapy only benefit more from anticoagulation or antiplatelet therapy, so this remains an area of controversy. Summary Transcatheter PFO closure is an evidence-based, guideline-supported therapy for secondary stroke prevention in patients with a PFO and cryptogenic stroke. However, proper patient selection is critical to achieve benefit, and recent studies have helped clarify those patients most likely to benefit from closure.

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Section: Patent Foramen Ovale Closurementioning

confidence: 99%

Secondary stroke prevention in patients with patent foramen ovale

Rhoades¹,

Tzeng²,

Ruggiero

2021

Current Opinion in Hematology

View full text Add to dashboard Cite

show abstract

Patent foramen ovale closure for secondary stroke prevention

Alkhouli

Sievert

Holmes

2019

European Heart Journal

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Transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke is gaining momentum after the recent publication of four randomized clinical trials suggesting its benefit. This article provides a contemporary overview of the anatomy and pathophysiology of PFO, the available diagnostic tools for the assessment and risk stratification of PFO, and the current and future landscape of PFO closure devices and their optimal utilization. It also summarizes the current data on PFO closure for stroke prevention, and discusses the remaining open issues in the field of PFO closure.

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Odyssey of Patent Foramen Ovale: Closure in Cryptogenic Stroke: The Canary in the Coal Mine of Clinical Trials?

Cited by 2 publications

References 14 publications

Secondary stroke prevention in patients with patent foramen ovale

Secondary stroke prevention in patients with patent foramen ovale

Patent foramen ovale closure for secondary stroke prevention

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