Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both

Abstract

Patients with both patent foramen ovale and atrial septal aneurysm who have had a stroke constitute a subgroup at substantial risk for recurrent stroke, and preventive strategies other than aspirin should be considered.

Closure, Anticoagulation, or Antiplatelet Therapy for Cryptogenic Stroke With Patent Foramen Ovale: Systematic Review of Randomized Trials, Sequential Meta‐Analysis, and New Insights From the CLOSE Study

“…This finding has pathophysiological plausibility, because it has been suggested that increased septal mobility may enhance the probability of paradoxical embolism by mechanically directing blood flow from the inferior vena cava into the PFO 35. It has also been shown that patients with both PFO and atrial septal aneurysm constitute a subgroup at substantial risk for recurrent stroke, compared with patients with PFO alone 6. Considering the low incidence rate of recurrent stroke in patients with cryptogenic stroke and PFO, closure confined to selected patients with anatomical features associated with a higher risk of stroke recurrence could be a more appropriate approach to enhance the benefits of PFO closure.…”

“…Heterogeneity was classified as moderate (I 2 ≥30%), substantial (I 2 ≥50%), or considerable (I 2 ≥75%) 23. Potential sources of heterogeneity were investigated by (1) stratifying studies according to the type of medical treatment in the control group (antithrombotic therapy or antiplatelet therapy alone); (2) conducting a subgroup analysis based on PFO anatomical features (higher‐risk PFOs, defined as PFO associated with atrial septal aneurysm or large shunt,6, 24 versus lower‐risk PFOs); and (3) by meta‐regression. Potential publication bias was investigated using funnel plots and Egger's test 25…”

“…Observational studies have demonstrated a strong association between patent foramen ovale (PFO) and cryptogenic stroke,3, 4 suggesting that paradoxical embolism through a PFO may be an important cause of otherwise unexplained ischemic strokes, notably in younger patients 5, 6. Three randomized controlled trials (RCTs) published in 2012 and 2013 (CLOSURE I (STARFlex Septal Closure System in Patients with a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale),7 PC Trial (Clinical Trial Comparing Percutaneous Closure of Patent Foramen Ovale Using the Amplatzer PFO Occluder with Medical Treatment in Patients with Cryptogenic Embolism),8 and RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment)9) failed to demonstrate the superiority of PFO closure over antithrombotic therapy (antiplatelet therapy or anticoagulants) to prevent recurrent stroke.…”

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

“…The PFO serves as a potential conduit for venous emboli to cross into the left atrium and eventually to the arterial circulation (Figure 1). The presence of an atrial septal aneurysm (ASA) has also been associated with cryptogenic stroke 10. An ASA is described as redundant bulging atrial septal tissue that can be caused by sustained interatrial pressure difference, or can be a primary malformation involving either the fossa ovalis or the entire atrial septum.…”

Closure of defects of the atrial septum in adults using the amplatzer device:100 consecutive patients in a single center

“…[1][2][3] Patent foramen ovale (PFO) is associated with stroke, systemic embolism, and neurological decompression illness in divers. [4][5][6][7] Surgical closure of ASD in adults carries low mortality but significant morbidity. [8][9][10] The optimum nonsurgical management of patients with PFO and embolism is unclear.…”