TY - JOUR
T1 - The role of device closure of patent foramen ovale in patients with cryptogenic stroke
AU - Fukutomi, M
AU - Wilkins, B
AU - Søndergaard, L
N1 - © 2020 The Association for the Publication of the Journal of Internal Medicine.
PY - 2020/10
Y1 - 2020/10
N2 - One of the most frequent causes of cardiac embolism in cryptogenic stroke is a paradoxical embolus, which originate from systemic venous source though an unidentified patent foramen ovale (PFO). PFO is a common finding in the general population with a prevalence of 25% to 30%. Transcatheter PFO device closure is known to be feasible and safety treatment for such patients. In recent years, several randomized controlled trials (RCTs) have been conducted to address the superiority of PFO closure over medical therapy alone in the prevention of stroke recurrence in patients with PFO. In contrast to findings from early 3 RCTs, recent 4 RCTs could successfully show the benefits of PFO device closure compared with medical therapy, with less peri- and postprocedural complication. Based on these data, PFO device closure is recommended to carefully select cryptogenic stroke patients aged from 18 to 65 years, with a high probability of a causal role of the PFO in stroke events. However, it is still uncertain whether PFO closure is superior to oral anticoagulants therapy in these patients. Therefore, further prospective randomized trials are needed to address the efficacy of PFO device closure to oral anticoagulants therapy.
AB - One of the most frequent causes of cardiac embolism in cryptogenic stroke is a paradoxical embolus, which originate from systemic venous source though an unidentified patent foramen ovale (PFO). PFO is a common finding in the general population with a prevalence of 25% to 30%. Transcatheter PFO device closure is known to be feasible and safety treatment for such patients. In recent years, several randomized controlled trials (RCTs) have been conducted to address the superiority of PFO closure over medical therapy alone in the prevention of stroke recurrence in patients with PFO. In contrast to findings from early 3 RCTs, recent 4 RCTs could successfully show the benefits of PFO device closure compared with medical therapy, with less peri- and postprocedural complication. Based on these data, PFO device closure is recommended to carefully select cryptogenic stroke patients aged from 18 to 65 years, with a high probability of a causal role of the PFO in stroke events. However, it is still uncertain whether PFO closure is superior to oral anticoagulants therapy in these patients. Therefore, further prospective randomized trials are needed to address the efficacy of PFO device closure to oral anticoagulants therapy.
KW - Cardiac Catheterization/adverse effects
KW - Cost-Benefit Analysis
KW - Foramen Ovale, Patent/complications
KW - Humans
KW - Ischemic Stroke/etiology
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Postoperative Complications
KW - Secondary Prevention
KW - Septal Occluder Device
U2 - 10.1111/joim.13143
DO - 10.1111/joim.13143
M3 - Review
C2 - 32812297
SN - 0954-6820
VL - 288
SP - 400
EP - 409
JO - Journal of Internal Medicine
JF - Journal of Internal Medicine
IS - 4
ER -