Closure of the patent foramen ovale in patients with embolic stroke of undetermined source: A clinical expert opinion and consensus statement for the Asian-Pacific region

Diener, Hans-Christoph; Akagi, Teiji; Durongpisitkul, Kritvikrom; Thomson, Viji Samuel; Prabhakar, Appaswamy Thirumal; Sharpe, Ross; Albers, Bert; Lewalter, Thorsten; Oki, Koichi; Sharma, Vijay K.

doi:10.1177/1747493020941658

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…The CLOSE ( 14 ), REDUCE ( 15 ) and RESPECT ( 16 ) studies about the closure of PFO with occluders were published on the New England Journal of Medicine journal in 2017, which proved that PFO occlusion could reduce the incidence of recurrent stroke more than drug therapy alone on certain conditions. Since then, many authoritative studies have been published, and guidelines in Europe ( 12 ), the United States ( 17 ), and even Asia Pacific ( 18 ) have been updated to support the use of PFO closure in the appropriate population. Therefore, our study is no longer focusing on the meaning and appropriate people of PFO closure, but discussing the safety and feasibility of a new guidance method with no angiographic guidance.…”

Section: Discussionmentioning

confidence: 99%

Only transesophageal echocardiography guided patent foramen ovale closure: A single-center experience

et al. 2022

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BackgroundAn increasing number of studies have proved that patent foramen ovale (PFO) occlusion could reduce the incidence of recurrent stroke more than drug therapy alone under certain conditions. Which is the “best” guidance technique still remains to be discussed.MethodsA single center retrospective study enrolled 120 patients (mean age 52.51 ± 14.29 years) who underwent PFO closure between April 2019 and March 2021. 87 patients (72.5%) had suffered cryptogenic stroke (CS) at least one time, and 24 patients (20%) had repetitive episodes of hemicrania unsourced. 65 patients were in the transesophageal echocardiography (TEE) guidance group (T-group), and the other 55 patients were in the angiographic guidance group (A-group).ResultsThere were no significant differences in crucial clinical characteristics between the two groups. In T-group, the procedural success rate was higher (100% vs. 92.7%, P = 0.028), and the procedural time was shorter (23.15 ± 13.87 vs. 25.75 ± 7.19, P = 0.001). No difference was detected in the procedural complication rate. Follow-up were performed at least 12 months. At 12 months, new atrial fibrillation occurred in 1 patient (1.5%) in the T-group and in 1 patient (1.8%) in the A-group (P = 0.905). Residual shunt occurred in 1 patient (1.5%) in the T-group and in 3 patients (5.5%) in the A-group (P = 0.236). Recurrent cerebral ischemia occurred in 2 patient (3.1%) in the T-group and in 2 patients (3.6%) in the A-group (P = 0.865).ConclusionThe use of only intra-procedural TEE guidance for PFO closure is safe and effective. The whole procedure can be performed without fluoroscopy and contrast medium. The short and medium follow-up results are satisfactory, especially in the residual shunt.

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Section: Discussionmentioning

confidence: 99%

Only transesophageal echocardiography guided patent foramen ovale closure: A single-center experience

et al. 2022

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“…Recently, a clinical expert opinion and consensus statement for the Asian-Pacific region were published (11). The statement suggests that Asians should comply with international guidelines on the indication for PFO closure, similar to European guidelines.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience of Percutaneous Patent Foramen Ovale Closure Using the Amplatzer PFO Occluder in Japanese Patients to Prevent the Recurrence of Cryptogenic Stroke

Takafuji¹,

Obunai²,

Makihara³

et al. 2021

Intern. Med.

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Objective Percutaneous patent foramen ovale (PFO) closure is a procedure widely used to prevent recurrence of cryptogenic stroke. Since December 2019, the Amplatzer PFO occluder device has been available in Japan through medical insurance. However, data on the clinical experience with this device are lacking, as it has been approved for use in only a limited number of institutions. This study assessed the clinical data of Japanese patients who underwent PFO closure using the Amplatzer PFO occluder. Methods Between February and October 2020, 14 patients at our institution underwent percutaneous PFO closure using the Amplatzer PFO occluder. The procedural characteristics, safety, and adverse events were retrospectively analyzed. Results The mean age of the patients was 52.4±13.3 years old, and 57.1% were women. Deep vein thrombosis was revealed in 2 patients, and the risk of paradoxical embolism score was 6.6±1.2 points. The PFO height and tunnel length were 2.3±1.4 mm and 11.5±4.1 mm. All patients had a PFO during the bubble study of grade >3 at the Valsalva maneuver on transthoracic echocardiography or transesophageal echocardiography. The average diameter of the PFO measured using a stiff guidewire and sizing balloon was 5.1±1.3 and 7.9±2.3 mm, respectively. Almost all cases (92.9%) were performed with a 25-mm device and without significant complications within approximately 1 h. Conclusion: Percutaneous closure using Amplatzer PFO occluder is a safe procedure for Japanese patients However, further investigations with a larger sample and longer follow-up are needed to confirm this result.

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“…Grade 3 (25 or more) and Grade 4 (visualization of the entire heart chamber) strongly suggest the presence of a PFO (Fig. 1) [5]. When the presence of a PFO is suspected following a contrast echo study, morphological evaluation by transesophageal echocardiography, that is, PFO height, tunnel length, and atrial septal aneurysm are evaluated [20].…”

Section: Diagnostic Process Of Pfomentioning

confidence: 99%

“…Three prospective controlled studies published in 2017 demonstrated that transcatheter closure of PFO significantly reduced the risk of recurrent paradoxical cerebral embolism compared with conventional antithrombotic therapy alone [2][3][4]. In Japan, transcatheter PFO closure has been approved as health insurance medical treatment since December 2019, and this procedure is gaining attention as a new therapeutic option for stroke prevention in young adults [5]. In 2020, the American Academy of Neurology reviewed previous criteria and stated that PFO closure probably reduces recurrent stroke risk in select patients, especially in patients younger than 60 years with a PFO and embolic-appearing infarct and where no other mechanism of stroke was identified.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter closure of patent foramen ovale: Current evidence and future perspectives

Akagi

2021

Journal of Cardiology

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Recent prospective controlled studies have demonstrated that transcatheter closure of a patent foramen ovale (PFO) reduces recurrent stroke risk in select patients, especially in patients younger than 60 years with PFO and embolic-appearing infarct and where no other mechanism of stroke was identified. Detection of PFO depends on the intensity of the Valsalva maneuver, and not all PFOs can be diagnosed using transesophageal echocardiography. Transthoracic contrast echocardiography using abdominal compression during the Valsalva maneuver is an easy method that can increase the detection sensitivity of PFO shunt. PFO with two or more of the following factors is most likely considered a "high-risk PFO" and as such, has a significantly higher probability of cryptogenic stroke: (1) a long-tunnel PFO (10 mm in length), (2) atrial septal aneurysm and/or hypermobile interatrial septum, (3) prominent Eustachian valve or Chiari's network, (4) large right-to-left shunt at rest and during the Valsalva maneuver, and (5) low-angle PFO. In order to establish the benefit of catheter-based PFO closure as a safe and effective treatment in clinical practice, the degree of accuracy of PFO diagnosis and its long-term safety need to be confirmed.

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Closure of the patent foramen ovale in patients with embolic stroke of undetermined source: A clinical expert opinion and consensus statement for the Asian-Pacific region

Cited by 6 publications

References 21 publications

Only transesophageal echocardiography guided patent foramen ovale closure: A single-center experience

Only transesophageal echocardiography guided patent foramen ovale closure: A single-center experience

Clinical Experience of Percutaneous Patent Foramen Ovale Closure Using the Amplatzer PFO Occluder in Japanese Patients to Prevent the Recurrence of Cryptogenic Stroke

Transcatheter closure of patent foramen ovale: Current evidence and future perspectives

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