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Which Patent Foramen Ovales Need Closure to Prevent Cryptogenic Strokes?
James E Dalen1, Joseph S Alpert1
1University of Arizona College of Medicine, Tucson.
The American Journal of Medicine
|November 28, 2017
Summary
Patent foramen ovale closure significantly reduces cryptogenic strokes in patients with atrial septal aneurysms. Closure is not indicated for those without aneurysms, highlighting a key factor in stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Patent foramen ovale (PFO) is more common in cryptogenic stroke patients.
- Paradoxical embolism through PFO is a suspected cause, though venous thromboembolism is rare.
- Transcatheter PFO closure has been explored as a stroke prevention strategy.
Purpose of the Study:
- To evaluate the efficacy of PFO closure versus medical therapy for cryptogenic stroke prevention.
- To identify patient subgroups who benefit most from PFO closure.
Main Methods:
- Analysis of data from randomized clinical trials comparing PFO closure with medical therapy.
- Stratification of results based on the presence or absence of an atrial septal aneurysm.
Main Results:
- Initial trials showed no significant advantage of PFO closure over medical therapy.
- Later trials with longer follow-up demonstrated a benefit.
- PFO closure significantly reduced strokes in patients with PFO and an atrial septal aneurysm (P < .001).
- No stroke reduction was observed in patients with PFO but without an atrial septal aneurysm (P = .37).
Conclusions:
- PFO closure is indicated for cryptogenic stroke patients with an accompanying atrial septal aneurysm.
- PFO closure is not indicated for patients with PFO but without an atrial septal aneurysm.
- Atrial septal aneurysms, identifiable by echocardiography, are a crucial factor in PFO-related stroke risk stratification.
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