Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke

Windecker, Stephan; Wahl, Andreas; Nedeltchev, Krassen; Arnold, Marcel; Schwerzmann, Markus; Seiler, Christian; Mattle, Heinrich; Meier, Bernhard

doi:10.1016/j.jacc.2004.05.044

Cited by 284 publications

(146 citation statements)

References 42 publications

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“…18 -20 Some data also suggest that specific PFO parameters, such as the degree of right-to-left shunting, the presence of atrial septal aneurysm, and PFO tunnel length, may increase the risk for thromboembolic events and may represent the cohort of patients who will receive the greatest benefit from device closure. 21,22 Of the 43 patients referred with the diagnosis of TIA, we suspect that 20 patients had complex MHs with transient neurologic deficits but no headaches. Differentiating between these 2 diagnoses remains a clinical dilemma because transient neurologic deficits such as paresthesia, hemiparesis, or aphasia can occur in patients with complex MHs.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Experience With Percutaneous Closure of Patent Foramen Ovale

Slavin

Tobis

Rangarajan

et al. 2007

The American Journal of Cardiology

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Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke, arterial desaturation, decompression illness, and migraine headache (MH). This study evaluated the safety of percutaneous transcatheter PFO closure in patients with cryptogenic stroke, transient ischemic attack, or arterial desaturation. Additionally, symptomatic reduction in MH was determined after interatrial shunt closure. Of the 252 patients referred to the University of California, Los Angeles, with PFO, 131 underwent closure of the interatrial communication with a CardioSEAL (n ‫؍‬ 30) or Amplatzer (n ‫؍‬ 101) device. PFO morphology was evaluated with transesophageal echocardiography. Follow-up was conducted at 1 to 2 months with echocardiography, with clinical assessment annually thereafter. At an average follow-up of 30 months, there was no recurrence of any thromboembolic event (transient ischemic attack, stroke, or peripheral). There was a reduction in MH, defined as the complete resolution of headache or a >50% reduction in the number of headache days, in 85% of patients after PFO closure. Temporary problems after device implantation, including chest discomfort and palpitations, were reported in 23% of patients and occurred more frequently in patients with nickel hypersensitivity (p <0.05). In conclusion, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events and MH associated with interatrial shunting in patients who present with cryptogenic stroke. Pending randomized, controlled trials are necessary to determine if this invasive approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with MH.

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Section: Discussionmentioning

confidence: 99%

Five-Year Experience With Percutaneous Closure of Patent Foramen Ovale

Slavin

Tobis

Rangarajan

et al. 2007

The American Journal of Cardiology

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“…Competing data regarding the reduction of stroke recurrence rate and potential drawbacks including periprocedural vascular complication, new-onset arrhythmias or device failure are still the matter of ongoing debate. Several randomized clinical trials and meta-analyses have not shown clear benefit of this procedure [25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Patient with patent foramen ovale and thrombophilia, after ischemic stroke, acute coronary syndrome and pulmonary embolism (RCD code: IV-2B.O)

Komar

Stępniewski

Przewłocki

et al. 2015

Journal of Rare Cardiovascular Diseases

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Patent foramen ovale (PFO) is a residue of the foramen ovale, an integral part of the normal fetal circulation. It closes in most of newborns, however 25-30% of adults may have it patent. Conditions such as crytpogenic stroke, migraine and vascular headaches or decompression sickness are strongly related to the presence of PFO. Less frequently acute myocardial infarction, renal infarction or acute mesenteric ischemia may also occur. We present a case of a 67-year-old man after cerebral ischemic episode, acute myocardial infarction treated with primary coronary intervention and pulmonary embolism, who was eventually diagnosed with PFO and factor V Leiden mutation. Life-long anticoagulation was initiated in this patient as a standard-of-care. He additionally underwent successful percutaneous PFO closure. As a result no subsequent thromboembolic complication occurred in this patient at the follow-up period. JRCD 2015; 2 (2): 52-55

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“…This advantage was significant in terms of major strokes, which only occurred in the conservative group. It was also significant in the subgroup of patients who had had more than two events before treatment allocation as well as in those who had complete closure at the six month follow up TEE in the device group (Windecker, Wahl & Nedeltchev, 2004).The few randomized trials in this field have, for years, struggled to enroll sufficient numbers of patients, owing to a variety of factors, including off-label device use.…”

Section: Catheter-based Pfo and Asd Closurementioning

confidence: 98%