Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials

Kheiri, Babikir; Abdalla, Ahmed; Osman, Mohamed A.; Ahmed, Sahar; Hassan, Mustafa; Bachuwa, Ghassan

doi:10.5603/cj.a2018.0016

Cited by 16 publications

(13 citation statements)

References 30 publications

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“…The incidence rate of adverse events was more than reported in clinical trials of closure for stroke. 21 In a prospective, single-centre study including non-PFO divers, divers with PFO and divers with closed PFO, the incidence rate of treated DCS (what corresponds to 'confirmed' DCS in our study) was reduced in both PFO groups in the post-intervention period. 20 However, the total burden of subjectively reported DCS increased in the PFO group after intervention while in the no-PFO and the closed-PFO groups the incidence rates decreased, as in our study.…”

Section: Discussionmentioning

confidence: 46%

The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale

Anderson¹,

Ebersole

Covington

et al. 2019

Diving Hyperb Med

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Introduction: Persistent (patent) foramen ovale (PFO) is a recognized risk for decompression sickness (DCS) in divers, which may be mitigated by conservative diving or by PFO closure. Our study aimed to compare the effectiveness of these two risk mitigation interventions. Methods: This was a prospective study on divers who tested positive for PFO or an atrial septal defect (ASD) and either decided to continue diving without closure ('conservative group'), or to close their PFO/ASD and continue diving ('closure group'). Divers' characteristics, medical history, history of diving and history of DCS were reported at enrollment and annually after that. The outcome measures were the incidence rate of DCS, frequency and intensity of diving activities, and adverse events of closure. Results: Divers in both groups dived less and had a lower incidence rate of confirmed DCS than before the intervention. In the closure group (n = 42) the incidence rate of confirmed DCS decreased significantly. Divers with a large PFO experienced the greatest reduction in total DCS. In the conservative group (n = 23), the post-intervention decrease in confirmed DCS incidence rate was not significant. Of note, not all divers returned to diving after closure. Seven subjects reported mild adverse events associated with closure; one subject reported a serious adverse event. Conclusions: PFO closure should be considered on an individual basis. In particular, individuals who are healthy, have a significant DCS burden, a large PFO or seek to pursue advanced diving may benefit from closure.

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Section: Discussionmentioning

confidence: 46%

The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale

Anderson¹,

Ebersole

Covington

et al. 2019

Diving Hyperb Med

View full text Add to dashboard Cite

show abstract

“…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%

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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“…[ 18 ] In reviewing the literature, some studies. [ 19 ] reported that paradoxical embolism was the main mechanism of CS caused by PFO. [ 20 ] However, only a small number of patients with CS could find the source of paradoxical embolism.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of the association of atrial septal abnormalities and atrial vulnerability

Sun

Zhou²,

Xu³

et al. 2021

Medicine

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Background: The mechanism of cryptogenic stroke (CS) in patients with atrial septal abnormalities remains unclear, and the increased incidence of atrial vulnerability may be one of the reasons. We performed this meta-analysis to clarify the association between atrial septal abnormalities and atrial vulnerability, and to provide evidence-based basis for the prevention and mechanism of CS. Methods: We systematically searched for studies on the association between atrial septal abnormalities and atrial vulnerability, and pooled available data on types of atrial septal abnormalities, types of atrial vulnerability, and methods of atrial vulnerability detection. The primary endpoints were the occurrence of atrial arrhythmias or P wave abnormalities. Random-effects models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: Twelve case-control studies were eligible. Compared with the control group, patients with atrial septal abnormalities had a higher risk of atrial vulnerability (OR: 1.93; 95% CI: 1.13-3.30, P = .02). Data based on stroke patients showed that the group with atrial septal abnormalities had a higher risk of atrial vulnerability than the control group (OR: 2.00; 95% CI: 1.13–3.53, P = .02). However, there was no significant difference in the incidence of atrial vulnerability between the 2 groups of nonstroke patients. Subgroup analysis showed that although atrial septal abnormality increased the risk of atrial vulnerability in the subgroup of atrial septal aneurysm (OR: 1.68; 95% CI: 0.47–5.95, P = .42), the subgroup of atrial fibrillation (AF)/atrial fluster (OR: 1.81; 95% CI: 0.94–3.46, P = .07) and the subgroup of subcutaneous recording system (OR: 1.33; 95% CI: 0.68–2.61, P = .41), the difference was not statistically significant. Conclusions: Atrial septal abnormalities can increase the risk of atrial vulnerability, and atrial arrhythmia caused by atrial septal abnormalities may be one of the mechanisms of CS.

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Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials

Abstract: Background: Cryptogenic strokes can be attributed to paradoxical emboli through patent

Cited by 16 publications

References 30 publications

The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale

The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale

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

A meta-analysis of the association of atrial septal abnormalities and atrial vulnerability

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