Percutaneous closure of patent foramen ovale: an underutilized prevention?

Stroke is a devastating event for patients and their families. Paradoxical embolism through a patent foramen ovale (PFO) is a recognized cause of stroke. Percutaneous PFO closure is a simple and safe procedure. The debate on PFO closure is far from settled. This is, in part, due to the fact that the three published randomized controlled trials (RCTs) on PFO closure vs. medical therapy were negative regarding their primary endpoint; however, as-treated and per-protocol analyses as well as several meta-analyses report a benefit of PFO closure. In our opinion, PFO closure is underutilized and the results of the three RCTs are not adequately reflected in the current guidelines.
Source: European Heart Journal - Category: Cardiology Authors: Tags: Clinical update Source Type: research

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Conditions:   Cryptogenic Stroke;   High Risk Patent Foramen Ovale Intervention:   Procedure: Percutaneous device closure Sponsors:   Asan Medical Center;   Medtronic Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Authors: Khan R Abstract Introduction: There has been considerable study assessing the treatment of cryptogenic stroke (CS) recently. This review examines the role of patent foramen ovale (PFO) closure in CS, while also discussing the evidence for alternative medical therapies in disease treatment.Areas Covered: PFO closure for treatment of CS has been assessed in 6 randomized controlled trials (RCTs). This review summarizes the background, results and limitations of these trials. Methodological and treatment-related differences in RCTs provide potential explanations for the discordance in outcomes observed between...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Cryptogenic Stroke/ESUS International Working Group defined embolic stroke of undetermined source (ESUS) as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation [1]. They presumed that as emboli are more likely to be thrombi, recurrence may be better prevented by anticoagulation rather than antiplatelet agents. Randomized trials with directly acting oral anticoagulants were suggested to test this hypothesis. But two randomised trials testing this aspect, NAVIGATE ESUS (Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
This study was undertaken to determine whether patients with a PFO would have a significantly increased risk of cerebrovascular accident (CVA) following TKA. The Humana national database was used to identify TKA patients who were stratified by the presence of a PFO from 2007 to 2016. Ninety-day follow-up was used for the primary outcome of CVA. Potential confounding comorbidities also were investigated, including age, sex, anticoagulation, insurance type, arrhythmia, valvular disease, peripheral vascular disease, chronic kidney disease, and diabetes mellitus. Of 153,245 TKAs, a total of 2272 patients had strokes; 479 of th...
Source: Orthopedics - Category: Orthopaedics Authors: Tags: Orthopedics Source Type: research
This study aims to investigate the utility of TTE as part of AIS workup.Methods: We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age>18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Source: Indian Journal of Pediatrics - Category: Pediatrics Source Type: research
New England Journal of Medicine, Ahead of Print.
Source: New England Journal of Medicine - Category: Internal Medicine Source Type: research
The REDUCE study demonstrated a reduction in the risk of recurrent stroke with patent foramen ovale closure and antiplatelet therapy compared to antiplatelet therapy alone. The clinicians were allowed to choose among aspirin, clopidogrel, or aspirin/dipyridamole with the expectation that all antiplatelet therapies would have similar efficacy in this population. We tested that presumption by comparing recurrent stroke rates among antiplatelet agents within the control arm of the trial.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
Authors: Nagarajarao HS, Ojha CP, Kedar A, Mukherjee D Abstract Cryptogenic stroke and its relation to the Patent foramen ovale (PFO) is a long debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between right and left atria in approximately 25-27% of adults [1, 2]. In this review we examine the clinical relevance of the PFO with analysis of latest trials eva...
Source: Cardiovascular and Hematological Agents in Medicinal Chemistry - Category: Cardiology Tags: Cardiovasc Hematol Agents Med Chem Source Type: research
Purpose of review Recent data have changed the landscape of patent foramen ovale (PFO) closure for secondary stroke prevention. This review synthesizes the data and provides a framework for optimal management of stroke patients with PFO. Recent findings The cumulative evidence indicates that PFO closure reduces the risk of recurrent stroke in carefully selected young cryptogenic stroke patients, with an annualized risk reduction of ∼0.6%. The benefit of PFO closure is particularly evident in patients with embolic appearing strokes, large right-to-left shunt, or an associated atrial septal aneurysm. There may be li...
Source: Current Opinion in Neurology - Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind Source Type: research
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