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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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Patent foramen ovale closure versus medical therapy for cryptogenic stroke: An updated systematic review and

Sunny Goel1, Shanti Patel1, Elina Zakin2

  • 1Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, 11219, USA.

Indian Heart Journal
|April 7, 2020
PubMed

Insights

Patent foramen ovale (PFO) closure significantly reduces stroke risk in cryptogenic stroke patients compared to medical therapy. However, PFO closure increases the risk of atrial fibrillation.

Area of Science:

  • Cardiology
  • Neurology
  • Interventional Cardiology

Background:

  • The efficacy of patent foramen ovale (PFO) closure for preventing recurrent cryptogenic stroke (CS) remains debated.
  • Medical management is the current standard, but its effectiveness in specific patient subgroups is under investigation.

Purpose of the Study:

  • To compare the safety and efficacy of PFO closure versus medical therapy in patients with CS.
  • To evaluate the impact of PFO closure on stroke recurrence and adverse events.

Main Methods:

  • A systematic review and meta-analysis of randomized control trials (RCTs) were conducted.
  • Searches included PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov.
  • Forest plots with random-effects models were used to compare event rates.

Main Results:

  • Six RCTs with 3747 patients were analyzed, with follow-up ranging from 2 to 5.9 years.
  • PFO closure significantly reduced stroke risk (RR=0.41) but increased atrial fibrillation risk (RR=5.29).
  • No significant differences were found in major bleeding or mortality; device closure was effective in patients with large shunts.

Conclusions:

  • PFO closure offers a significant stroke risk reduction compared to medical management for CS patients.
  • Increased risk of atrial fibrillation is a key consideration with PFO closure.
  • Device closure efficacy is particularly noted in patients with large shunt sizes.
Abstract

Keywords:
Antiplatelet therapyAtrial fibrillationCryptogenic strokePatent foramen closureRecurrent stroke

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