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Interventional prevention of paradoxical embolism as the gold standard: End of discussion?

Radomir Nykl1, Jan Precek1, Martin Sluka1

  • 1Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic.

Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
|June 23, 2021
PubMed

Insights

Patent foramen ovale (PFO) closure can prevent cryptogenic stroke in carefully selected patients. However, evidence on its superiority over medical therapy remains debated, especially for smaller shunts.

Area of Science:

  • Cardiology
  • Neurology
  • Interventional Cardiology

Background:

  • Paradoxical embolism, often due to a patent foramen ovale (PFO), is a significant cause of cryptogenic stroke.
  • Interventional closure of PFO is a debated secondary prevention strategy.

Purpose of the Study:

  • To provide a comprehensive review of PFO closure for cryptogenic stroke prevention.
  • To analyze current data and guidelines regarding PFO closure versus pharmacotherapy.

Main Methods:

  • Systematic review and meta-analysis of available clinical trials and guidelines.
  • Critical evaluation of study methodologies, patient selection, and outcome data.

Main Results:

  • Large trials show conflicting results regarding PFO closure superiority over pharmacotherapy.
  • Studies demonstrating superiority often involved patients with large shunts.
  • Controversies include lack of comparison with modern anticoagulants and intervention risks.

Conclusions:

  • PFO closure is a viable secondary prevention for cryptogenic stroke in select patients.
  • Careful patient selection is crucial for successful interventional treatment.
  • Further research is needed to clarify optimal patient populations and compare with advanced medical therapies.

Keywords:
catheterization PFO closureinteratrial septal aneurysmparadoxical embolismpatent foramen ovale

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