RESPECT "device-in-place" analysis: Benefits of PFO closure?
A new post hoc "device-in-place" analysis of the RESPECT trial of patent foramen ovale closure in secondary stroke prevention has shown a magnification of benefits in comparison with the intention-to-treat or per-protocol analyses presented previously.
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Patent foramen ovale (PFO) is a common cardiac anatomic variant that has been increasingly found in young (
Conclusion: In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.
Abstract Cardiogenic stroke (CS), characteristic causes of which include atrial fibrillation (AF) and right-to-left shunting due to a patent foramen ovale (PFO), has a well-known tendency to be associated with a more extensive ischemic area. This may result in severe neurological damage, and require strict life-long antithrombotic therapy. However, the fact that some patients have problems complying with the requirement for extended oral antithrombotic treatment has motivated the development of alternative approaches for stroke prevention. Heart structures such as the left atrial appendage (LAA) and PFO are potent...
Patent foramen ovale (PFO) is a potential cause of cryptogenic cerebrovascular events (c-CVEs). A score has been developed to identify stroke-related versus incidental PFO in c-CVEs. The Risk of Paradoxical Embolism (RoPE) score indicates that otherwise healthy young adults with a high score are likely to have pathogenic PFO.1 –3 Until recently, there was a lack of evidence for routine closure of PFO in patients who suffered from c-CVEs.4–6 However, three recent randomized studies showed a benefit of transcatheter PFO closure compared with medical therapy.
CONCLUSION: Compared with drug therapy, PFO closure reduced the risk of recurrent stroke among patients with a risk score of ≥2 and reduced the incidence of serious bleeding without increasing the risk of new-onset atrial fibrillation or atrial flutter. PMID: 32394019 [PubMed - as supplied by publisher]
Abstract BACKGROUND: Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown. OBJECTIVE: To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA). DESIGN: Prospective cohort study comparing stroke or TIA recurrence in patients with and without residual shunt after PFO closure. SETTING: Single hospital center. PARTICIPANTS: 1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic ...
ConclusionsConclusions: cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.
We present a case report of a patient with a pulmonary embolus placed on venoarterial extracorporeal membrane oxygenation who developed venous cannula migration through an undiagnosed patent foramen ovale causing an ischemic stroke due to a thrombus and requiring thrombectomy and device closure of the atrial defect.
Conclusion: VTE can be detected in patients with CS linked to PFO. While –based on the presented literature–routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.