Patent Foramen Ovale Closure—Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions

Yeh, Robert W.; Yeh, Doreen DeFaria

doi:10.1001/jama.2021.21317

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…As mentioned in recent investigations, risk reduction for recurrent stroke with device closure varied across groups classified by their probabilities that the stroke was causally related to the PFO. 27,28 Meanwhile, both the uncertainties regarding the degree of benefit after closure and the higher risk of AF should be considered in the decision-making process when evaluating old patients with presumed PFO-related stroke.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events

Alperi

Guedeney²,

Horlick

et al. 2022

Circ: Cardiovascular Interventions

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Background: The main randomized trials evaluating patent foramen ovale (PFO) closure after a presumed PFO-associated stroke excluded patients older than 60 years. We aimed to evaluate the early- and long-term clinical outcomes of transcatheter PFO closure in older (>60 years) patients with a cryptogenic ischemic event. Methods: This is a multicenter study including consecutive patients older than 60 years (mean age, 67±5 years) who had a PFO closure following a presumed PFO-related ischemic event. Patients ≤60 years old (mean age, 44±10 years) served as the control group. The primary end point was the occurrence of stroke, transient ischemic attack, or peripheral embolism over the follow-up period. New-onset atrial fibrillation was a secondary end point. Results: A total of 388 and 883 patients >60 and ≤60 years old were included, respectively. Procedural success rate was high (99.9%), and procedural-related complications low (<2%) in both groups. After a median follow-up of 3 (1–8) years, older patients exhibited an incidence of stroke/transient ischemic attack/peripheral embolism of 1.6 events per 100 patient-years (stroke: 0.6 events per 100 patient-years), lower than that expected according to the risk of paradoxical embolism score (observed-to-expected ratio, 0.31 [95% CI, 0.11–0.91]). However, the event rate in older patients was higher than that observed in their younger counterparts (incidence rate ratio, 4.7 [95% CI, 2.36–9.8]). De novo atrial fibrillation after the procedure was more frequent in older patients (2.66 per 100 patient-years versus 0.49 per 100 patient-years, P <0.001). Conclusions: In patients older than 60 years with a presumed PFO-related ischemic event, PFO closure was safe and associated with a relatively low incidence of recurrent ischemic events after a median follow-up of 3 years compared with historical cohorts of patients who did not undergo PFO closure. However, a higher risk of recurrent cerebrovascular events was observed in older patients compared to their younger counterparts. Randomized trials are warranted in this population.

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Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events

Alperi

Guedeney²,

Horlick

et al. 2022

Circ: Cardiovascular Interventions

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“…Despite our encouraging results, we suggest that patients with a known ASD/PFO contemplating TJA should be evaluated by the cardiology team to determine the possible benefits and risks of defect closure, particularly in patients with predisposing factors for thromboembolism [ 6 ]. Four recent studies demonstrated significant reductions in rate of recurrent stroke after PFO closure in comparison to medical treatment, and the American Academy of Neurology redefined the guidelines accordingly [ [16] , [17] , [18] , [19] , [20] ]. Murphy et al.…”

Section: Discussionmentioning

confidence: 99%

Total Joint Arthroplasty in Patients With Atrial Septal Defects: What Are the 90-Day Complications?

et al. 2022

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“…The role of patent foramen ovale closure was previously controversial in cryptogenic stroke. However, several recent trials have provided new data on the role of patent foramen ovale closure for secondary stroke prevention [58]. Consequently, the American Academy of Neurology released a practice update in 2020 stating that it is reasonable to recommend patent foramen ovale (PFO) closure in patients under 60 with embolic appearing stroke, with no other apparent mechanism of stroke, after careful consideration of the risks and benefits of the procedure [59 ▪▪ ].…”

Section: Specific Considerations By Stroke Etiologymentioning

confidence: 99%

Stroke in the young

Fraser

Pabst

Smith

2023

Current Opinion in Neurology

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Purpose of reviewThe purpose of this review is to review recent findings regarding stroke epidemiology, etiologies, and treatment in children and young adults.Recent findingsIncidence in young adults is increasing, and incidence, recurrence, and survival is worse in patients with cryptogenic stroke and in developing countries. Careful consideration of patent foramen ovale closure is now recommended in young adults with cryptogenic stroke. Thrombectomy has recently been extended to carefully selected children with acute ischemic stroke, and two recent publications strongly suggest that it can be beneficial for children. Sickle cell is also an important global contributor to stroke burden, but hydroxyurea can be a cost effective medication for stroke prevention in children. Recent advances in genetic testing and treatments may improve outcomes for patients with monogenic causes of stroke, such as deficiency of adenosine deaminase 2, hemophilia, and Fabry's disease.SummaryStroke in children and young adults is a morbid disease responsible for enormous indirect societal costs and a high burden of years with disability per affected patient. Recent advances have improved access to care for children with large vessel occlusion and adults with rare causes of stroke. Future research may bring effective treatments for other monogenic causes of stroke as well as increasing access to hyperacute therapies for young stroke patients.

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Patent Foramen Ovale Closure—Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions

Cited by 3 publications

References 20 publications

Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events

Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events

Total Joint Arthroplasty in Patients With Atrial Septal Defects: What Are the 90-Day Complications?

Stroke in the young

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