Uncertainties and Controversies in the Management of Ischemic Stroke and Transient Ischemic Attack Patients With Patent Foramen Ovale

Kasner, Scott E.; Lattanzi, Simona; Fonseca, Ana Catarina; Elgendy, Akram Y.

doi:10.1161/strokeaha.121.034778

Cited by 15 publications

(28 citation statements)

References 92 publications

(215 reference statements)

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“…Until 2017, the results of CLOSE [ 7 ], Gore REDUCE [ 8 ], and Long-Term Outcomes of RESPECT study [ 6 ] showed that PFO closure significantly reduced the recurrence rate of ischemic stroke in patients with CS. Multiple trial-level meta-analyses have confirmed the efficacy of closure, yielding an odds ratio (OR) of 0.44 compared with MT alone [ 9 , 22 – 24 ]. Subgroup analyses showed the benefit of PFO closure was significant in patients with PFO associated with substantial RLS or ASA [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…New-onset AF is the commonest complication after PFO closure, with an incidence of 2.9%-6.6% [ 29 , 30 ]. AF mainly occurs within 30 days after the device implantation, possibly due to local inflammation after device implantation, irritation or stretching of the interatrial septum during device deployment, or the specific use of an umbrella-clamshell device [ 9 ]. As reported, 72% of new-onset AF recovered within 45 days spontaneously and would not increase the risk of ischemic stroke [ 1 , 7 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 2017, the results of three multicenter randomized controlled trials (RCT) [ 6 – 8 ] showed that transcatheter closure of PFO is a better therapy in patients with CS than medical therapy (MT) alone. Multiple trial-level meta-analyses have confirmed the efficacy of closure for stroke prevention [ 9 ]. The current consensus is that the key to successful PFO closure is a comprehensive assessment to select the optimal candidates in patients with CS.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Patent Foramen Ovale Closure in Patients with Cryptogenic Stroke or Transient Ischemic Attack: A Retrospective Study

Liu

Hui

et al. 2022

BioMed Research International

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Background. Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS). Transcatheter closure of PFO is superior to pharmacotherapy for patients with CS or transient ischemic attack (TIA). More evidence is needed to evaluate the efficacy and safety of PFO closure in Chinese patients. Methods. This study enrolled ten CS patients and two TIA patients (mean age of 40.8 ± 9.7 y), including seven males (58%) and five females (42%) who underwent PFO closure in our center from January 2017 to July 2019. Baseline data, imaging data, and RoPE (Risk of Paradoxical Embolism) score were collected retrospectively. The preprocedural assessment and percutaneous transcatheter PFO closure were described in detail. The perioperative complications and follow-ups were recorded from all patients. Results. Among ten patients with CS, eight patients had a RoPE score of >6 and two patients had a RoPE score of 6. MRI confirmed multiple infarcts in seven cases, and infarct involving the cortex in nine cases. Abnormal ECG was found in three patients and abnormal Echo in four patients. Right-to-left shunt (RLS) was detected in all the patients by cTCD or cTTE. To be specific, RLS was observed in nine of the ten TEE-detected patients. No case had PFO complicated with atrial septal aneurysm (ASA). The success rate of PFO closure was 91.6%. No serious perioperative complications were observed. During a mean time of 26.5 ± 8 months (15-41 months) of follow-up, no recurrent cerebral infarction, TIA, or thromboembolism were detected in postoperative patients. Conclusions. PFO closure is safe and effective in the treatment of Chinese patients with CS or TIA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percutaneous Patent Foramen Ovale Closure in Patients with Cryptogenic Stroke or Transient Ischemic Attack: A Retrospective Study

Liu

Hui

et al. 2022

BioMed Research International

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“…[9][10][11][12] Despite the clinical evidence for PFO closure in CS patients, many questions remain unanswered. 24 First, most previous trials were conducted in young patients (<60 years), and the benefit of PFO closure in elderly patients remains unknown. Although the greatest added benefit of PFO closure plus medical therapy compared with medical therapy alone was found in patients with both a high RoPE score and a high-risk PFO (socalled probable PASCAL), 8 this observation may in part be attributed to the fact that older patients were excluded from the analysis.…”

Section: Discussionmentioning

confidence: 99%

Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

et al. 2022

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The online 2021 Asian-Pacific Heart and Brain Summit was organized to present and discuss experiences within leading Asian-Pacific centers with regard to institutional heart and brain teams managing the diagnosis, treatment, and follow-up of cryptogenic stroke (CS) patients with patent foramen ovale (PFO). This manuscript presents a narrative review of presentations and discussions during the summit meeting. Percutaneous PFO closure is an established therapy for CS patients in whom PFO is considered to be causal. Guidelines and consensus statements emphasize the importance of multidisciplinary clinical decision-making regarding PFO closure with the involvement of several clinical specialties, including neurology, cardiology, and hematology. It is also recommended that the patient be closely involved in this process. The heart and brain team is a collaborative platform that facilitates such a multidisciplinary decision-making process and patient involvement. It also creates opportunities for education and evaluation of the healthcare provided to patients with CS. This review provides insights into the implementation, composition, organization, and operation of a heart and brain team. Methods and metrics are suggested to evaluate the team’s role. We suggest that an efficient heart and brain team can implement guideline-recommended multidisciplinary clinical decision-making with regard to PFO closure in CS patients and play an important role in the management of these patients.

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“…Merke Da die Wirksamkeit des interventionellen PFO-Verschlusses bei kryptogenem Schlaganfall bei Patienten im Alter < 60 Jahre belegt ist, sollte diese Patientengruppe nicht mehr unter dem Label ESUS subsumiert werden [40,41]. Die neue Bezeichnung ist PFO-assoziierter Schlaganfall [41].…”

Section: Persistierendes Foramen Ovaleunclassified

Neues in der Prävention des Schlaganfalls

Diener¹,

Endres²,

Gerloff³

et al. 2022

Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie,

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Uncertainties and Controversies in the Management of Ischemic Stroke and Transient Ischemic Attack Patients With Patent Foramen Ovale

Cited by 15 publications

References 92 publications

Percutaneous Patent Foramen Ovale Closure in Patients with Cryptogenic Stroke or Transient Ischemic Attack: A Retrospective Study

Percutaneous Patent Foramen Ovale Closure in Patients with Cryptogenic Stroke or Transient Ischemic Attack: A Retrospective Study

Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

Neues in der Prävention des Schlaganfalls

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