Percutaneous patent foramen ovale closure is superior to medical treatment alone in preventing recurrent stroke
1. Patent foramen ovale (PFO) closure was superior to medical treatment alone in preventing transient ischemic attack (TIA) and recurrent stroke.
2. However, PFO closure also raised the risk of atrial fibrillation (AF) or atrial flutter (AFL) in people with PFO and cryptogenic stroke.
Study Rundown: Individuals with a PFO have a heightened risk of cardioembolic cerebrovascular accident. Since PFO could possibly be a location for formation of a thrombus or a path for paradoxical embolism, percutaneous closure may be used to prevent recurrent stroke in people at high-risk. Current guidelines do not recommend PFO closure on a routine basis, but data from two new randomized trials in late 2017 were not yet factored into these guidelines. Using information from multiple databases, this systematic review and meta-analysis reviewed new data for recurrent cerebrovascular events in individuals with PFO and cryptogenic stroke who were treated with PFO closure compared to those who were treated using only medical therapy. The authors found that PFO closure was superior to medical treatment alone in preventing TIA and recurrent stroke. However, PFO closure also raised the risk of AF or AFL in people with PFO and cryptogenic stroke. Therefore, the authors suggest that cardiac imaging should be used to assist in the careful selection of candidates for PFO closure.
A strength of the study is that it includes the latest data from two recently concluded randomized trials. Limitations of the study include heterogeneous inclusion criteria and the lack of double-blind trials.
In-Depth [systematic review and meta-analysis]: The authors used PubMed, Scopus, Google Scholar, reference lists, abstracts from relevant scientific sessions, and cardiology web sites to search for randomized controlled trials that evaluated PFO closure (using a device that is currently available) in comparison to medical treatment alone and that included results for rates of stroke, TIA, AF, or AFL. Four trials met this criteria: PC, RESPECT, REDUCE, and CLOSE. These trials involved a total of 2 531 patients. The trials showed that PFO closure decreased the risk for stroke or TIA (risk difference [RD] -0.029) but raised the risk of AF or AFL (RD 0.033). The advantage of PFO closure was linked to the use of larger interatrial shunts (p = 0.034).
©2018 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.
Next Article in Stroke
Neurology Advisor Articles
- OCD in Duchenne Muscular Dystrophy Features Distinct Phenotype, Associated Symptoms
- History of Migraine Associated With Higher Risk for Cochlear Disorders
- Vagus Nerve Stimulation in Pediatric Epilepsy: Weighing the Risks and Benefits
- High Treatment Adherence and Quality of Life Observed With Fingolimod
- Gender Differences in the Epidemiology of Migraine
- Some Statins May Be Associated With Cognition, Memory Deficits
- Neuropathic Pain Treatments
- Cannabis for Multiple Sclerosis: Prescriber's Perspective
- New Monoclonal Antibody BAN2401 Reduces Amyloid Plaques, Improves Cognition in Alzheimer's
- Nonpharmacologic Interventions for Alzheimer's Have Greater Impact on Outcomes Than Currently Available Medications
- Associations Identified Between Stroke Severity, Recovery of Visuospatial Neglect
- Action Tremor May Have Central Origin in Motor Neuron Disease
- Characteristics Affecting Health-Related Quality of Life in RRMS, Progressive MS
- Neurodevelopmental Anomalies, Birth Defects Linked to Zika ID'd
- Childbearing Surgical Residents Often Feel Career Dissatisfaction