Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis

Wolfrum, Mathias; Froehlich, Georg M; Knapp, Guido; Casaubon, Leanne K.; DiNicolantonio, James J.; Lansky, Alexandra J.; Meier, Pascal

doi:10.1136/heartjnl-2013-304394

Cited by 70 publications

(40 citation statements)

References 34 publications

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“…Several meta-analyses published over the past decade demonstrated the potential benefit and superiority of PFO closure for preventing stroke recurrence compared with medical therapy alone [16-24]. Results of all included studies demonstrated the superiority of PFO closure compared to medical therapy alone.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials

et al. 2018

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Background: Patent foramen ovale (PFO) with atrial septal aneurysm is suggested as an important potential source for cryptogenic strokes. Percutaneous PFO closure to reduce the recurrence of stroke compared to medical therapy has been intensely debated. The aim of this study is to assess whether PFO closure in patients with cryptogenic stroke is safe and effective compared with medical therapy. Method: A search of PubMed, Medline, and Cochrane Central Register from January 2000 through September 2017 for randomized controlled trails (RCT), which compared PFO closure to medical therapy in patients with cryptogenic stroke was conducted. We used the items “PFO or patent foramen ovale”, “paradoxical embolism”, “PFO closure” and “stroke”. Data were pooled for the primary outcome measure using the random-effects model as pooled rate ratio (RR). The primary outcome was reduction in recurrent strokes. Result: Among 282 studies, 5 were selected. Our analysis included 3,440 patients (mean age 45 years, 55% men, mean follow-up 2.9 years), 1,829 in the PFO closure group and 1,611 in the medical therapy group. The I² heterogeneity test was found to be 48%. A random effects model combining the results of the included studies demonstrated a statistically significant risk reduction in risk of recurrent stroke in the PFO closure group when compared with medical therapy (RR 0.42; 95% CI 0.20–0.91, p = 0.03). Conclusion: Pooled data from 5 large RCTs showed that PFO closure in patients with cryptogenic stroke is safe and effective intervention for prevention of stroke recurrence compared with medical therapy.

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Section: Discussionmentioning

confidence: 99%

Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials

et al. 2018

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“…2). This incomplete fusion results in a pouch that, in the majority of instances, communicates with the left atrium cavity [49]. The presence of LASP with access to the systemic circulation also raises the possibility that, similar to the LAA, during low-flow states, this pouch might serve as a site for thrombus formation and embolization.…”

Section: Pouches Of Left Atrial Septummentioning

confidence: 99%

Established and potential echocardiographic markers of embolism and their therapeutic implications in patients with ischemic stroke

Gąsiorek

Banach

Maciejewski³

et al. 2019

Cardiol J.

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Cardiogenic strokes comprised 11% of all strokes and 25% of ischemic strokes. An accurate identification of the cause of stroke is necessary in order to prepare an adequate preventive strategy. In this review the confirmed and potential causes of embolic strokes are presented, which can be detected in echocardiography in the context of present treatment guidelines and gaps in evidence. There remains a need for further studies assessing the meaning of potential cardiac sources of embolism and establishment of rules for optimal medical prevention (antiplatelet therapy [APT] vs. oral anticoagulation [OAC]) and interventional procedures to reduce the incidence of ischemic strokes. Currently available data does not provide definitive evidence on the comparative benefits of OAC vs. APT in patients with cryptogenic stroke or embolic stroke of undetermined source. There is a lack of antithrombotic treatment scheme in the time between stroke and the completed diagnosis of potential sources of thromboembolism.

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“…[8][9][10] A recent meta-analysis that combined the results of these 3 RCT showed that the weighted incidence of recurrent stroke was 1.7% in the closure group and 2.9% in the best medical therapy group. 14 The relative risk for stroke was lower after PFO closure (relative risk, 0.66; 95% confidence interval, 0.37-1.19; P=0.171).…”

Section: Association Of Pfo and Cryptogenic Strokementioning

confidence: 99%

Recurrent Paradoxical and Pulmonary Embolism, Hypercoagulable State, and Patent Foramen Ovale

Naqvi

Sadiq

Goldberg³

2016

Circulation

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Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis

Cited by 70 publications

References 34 publications

Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials

Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials

Established and potential echocardiographic markers of embolism and their therapeutic implications in patients with ischemic stroke

Recurrent Paradoxical and Pulmonary Embolism, Hypercoagulable State, and Patent Foramen Ovale

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