Embolic stroke of undetermined source and patent foramen ovale closure: Practice insights from meta ‐analysis?

Key Points Closure of patent foramen ovale (PFO) in embolic stroke of undetermined source (ESUS) reduces recurrent stroke compared with antiplatelet therapy in select patients but increases risk of atrial fibrillation. Device closure is an attractive option for young patients with an anatomically higher risk PFO and imaging proven ESUS. Benefit of PFO closure in ESUS compared with oral anticoagulation remains undefined.
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Valvular and Structural Heart Diseases Source Type: research

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AbstractPurpose of reviewCryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation, hypercoagulable state or undiagnosed malignancy. Because many of these proposed mechanisms are embolic – and based on studies of thrombus history showing commonalities between thrombus composition between cardioembolic and cryptogenic strokes – the concept of embolic stroke of undetermined source (ESUS) (Hart et al....
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - Category: Neurology Source Type: research
Conclusion Young patients with cryptogenic strokes seem to benefit from endovascular closure of a PFO in the presence of a large right-to-left shunt or an associated atrial septum aneurysm. For most other patients, a highly-individualized decision must be made, taking into account the low risk of recurrence in patients with a cryptogenic stroke attributable to a PFO, the high numbers needed to treat and the risks related to the procedure.RESUMO O tratamento de pacientes com infarto cerebral criptog ênico e forame oval patente (FOP) é controverso. Uma revisão crítica destes estudos é aprese...
Source: Arquivos de Neuro-Psiquiatria - Category: Neurology Source Type: research
Publication date: Available online 22 October 2019Source: Indian Heart JournalAuthor(s): Sunny Goel, Shanti Patel, Elina Zakin, Ravi Teja Pasam, Joseph Gotesman, Bilal Ahmad Malik, Sergey Ayzenberg, Robert Frankel, Jacob ShaniAbstractObjectivesTo compare safety and efficacy of Patent Foramen Ovale (PFO) closure compared with medical therapy in patients with cryptogenic stroke (CS)BackgroundThe role of PFO closure in preventing recurrent stroke in patients with prior CS has been controversial.MethodsWe searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at ...
Source: Indian Heart Journal - Category: Cardiology Source Type: research
Gore won the European CE Mark for its GORE CARDIOFORM ASD Occluder, a device designed for percutaneous, transcatheter closure of ostium secundum atrial defects (ASDs). The occluder recently completed a clinical study involving 125 patients with ASD, ...
Source: Medgadget - Category: Medical Devices Authors: Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
AbstractFew data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1  year (2017, November 1st–2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ±&thi...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
The GORE CARDIOFORM Septal Occluder has been approved by the FDA to treat ostium secundum atrial septal defects (ASD) via percutaneous closure procedures. In a clinical study of the device in 125 patients with ASD, ranging in age from 2 to 84, all wh...
Source: Medgadget - Category: Medical Devices Authors: Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs
ConclusionPreclinical models suggest a key role for enhanced SD susceptibility and microembolization to explain both the occurrence of migraine attacks and the increased stroke risk in migraineurs. Therapeutic targeting of SD and microembolic events, or potential causes thereof, will be promising for treatment of aura and may also prevent ischemic infarction in vulnerable brains.
Source: The Journal of Headache and Pain - Category: Neurology Source Type: research
Authors: Campbell BC Abstract In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imagi...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Abstract BACKGROUND: A few randomized clinical trials (RCT) and their meta-analyses have found patent foramen ovale closure (PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains unclear. AIM: To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs. METHODS: Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for...
Source: World Journal of Cardiology - Category: Cardiology Authors: Tags: World J Cardiol Source Type: research
More News: Atrial Fibrillation | Cardiac Catheterization | Cardiology | Cardiovascular | Cardiovascular & Thoracic Surgery | Heart | Patent Foramen Ovale | Stroke