Recurrent Stroke Risk Reduced With Patent Foramen Ovale Closure

HealthDay News — Percutaneous and transcatheter patent foramen ovale (PFO) closure prevent recurrent stroke in adults with PFO and cryptogenic stroke, according to 2 reviews published online in the Annals of Internal Medicine.

Salvatore De Rosa, MD, PhD, from the Magna Graecia University in Catanzaro, Italy, and colleagues conducted a systematic review to compare the risks for recurrent cerebrovascular events in adults with PFO and cryptogenic stroke who underwent percutaneous PFO closure vs medical therapy alone. Four of five trials used commercially available devices. The researchers found that in these 4 trials, with 2531 patients, PFO closure correlated with reduced risk of the main outcome of stroke or transient ischemic attack (risk difference, −0.029) and increased risk for new-onset atrial fibrillation (AF) or atrial flutter (risk difference, 0.033).

Rahman Shah, MD, from the University of Tennessee in Memphis, and colleagues conducted a review to compare transcatheter PFO closure with medical therapy alone in patients with PFO and cryptogenic stroke. One of the five trials was excluded as it used a device that is no longer available. Based on 4 trials with 2892 patients, the researchers found that PFO closure correlated with a 3.2% reduction in the absolute risk for recurrent stroke (risk difference, −0.032) compared with medical therapy. PFO closure correlated with increased rates of new-onset AF, but there was marked between-trial heterogeneity for this outcome.

“Because recurrent stroke rates are low even with medical therapy alone and PFO closure might affect AF risk, shared decision making is crucial for this treatment,” Shah and colleagues write.

Two authors from the De Rosa study disclosed financial ties to the pharmaceutical and medical device industries.

References

1. De Rosa S, Sievert H, Sabatino J, Polimeni A, Sorrentino S, Indolfi C. Percutaneous closure versus medical treatment in stroke patients with patent foramen ovale: a systematic review and meta-analysis [published online January 9, 2018]. Ann Intern Med. doi:10.7326/M17-3033
2. Shah R, Nayyar M, Jovin IS, et al. Device closure versus medical therapy alone for patent foramen ovale in patients with cryptogenic stroke: a systematic review and meta-analysis [published online January 9, 2018]. Ann Intern Med. doi:10.7326/M17-2679