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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence

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Percutaneous closure versus medical therapy for stroke with patent foramen Ovale: a systematic review and

Xin-Lin Zhang1, Li-Na Kang1, Lian Wang1

  • 1Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, 321 Zhongshan Road, Nanjing, 210008, China.

BMC Cardiovascular Disorders
|March 4, 2018
PubMed

Insights

Patent foramen ovale (PFO) closure significantly reduces stroke risk in cryptogenic stroke patients but increases risks for atrial fibrillation and pulmonary embolism compared to medical therapy.

Area of Science:

  • Cardiology
  • Neurology
  • Interventional Medicine

Background:

  • Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke.
  • PFO closure is considered for secondary stroke prevention.
  • Comparative data on PFO closure versus medical therapy for stroke is limited.

Purpose of the Study:

  • To evaluate the comparative efficacy and safety of PFO closure versus medical therapy in patients with PFO and cryptogenic stroke.
  • To synthesize evidence from randomized controlled trials (RCTs) and observational studies.

Main Methods:

  • Systematic review and meta-analysis of 20 studies (5 RCTs, 15 observational).
  • Included studies compared PFO closure with medical therapy.
  • Minimum 20 patients in the closure arm and 1-year follow-up required.

Main Results:

  • PFO closure significantly reduced the composite outcome of ischemic stroke, transient ischemic attack (TIA), or all-cause death (OR 0.57).
  • Stroke incidence was significantly lower with PFO closure (OR 0.39).
  • PFO closure increased risks for atrial fibrillation/flutter (OR 5.74) and pulmonary embolism (OR 3.03).

Conclusions:

  • PFO closure is effective in reducing stroke recurrence and a composite of stroke, TIA, or death.
  • Increased risks of atrial fibrillation/flutter and pulmonary embolism necessitate careful patient selection and monitoring.
  • Evidence suggests PFO closure is a viable secondary prevention strategy with a specific risk profile.
Abstract

Keywords:
Cryptogenic strokeMedical therapyMeta-analysisPatent foramen ovalePercutaneous closure

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