Patent foramen ovale and stroke: current evidence and treatment options

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 little or no benefit in patients with small deep infarcts, a small PFO, or an indication for long-term anticoagulation. Closure is accompanied by a small risk of major procedural complication and atrial fibrillation. Summary The annual risk of stroke from PFO is low relative to other stroke mechanisms, but the life-time cumulative risk in young patients who have experienced a prior stroke may be substantial, in which case the absolute benefit of closure is likely impactful. PFO is highly prevalent in the general population, present in about one in four adults, and should not be considered to be the cause of the stroke until a thorough workup has excluded alternative mechanisms.
Source: Current Opinion in Neurology - Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind 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
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 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
Background: The efficacy of patent foramen ovale (PFO) closure remains controversial, and it is unclear which patient groups are best benefited. We performed this meta-analysis to clarify the efficacy of PFO closure of younger patients for prevention of recurrent ischemic neurological events. Methods: We systematically searched for studies of PFO closure for younger patients under the age of 55, and pooled available data on PFO closure of younger vs older patients and on PFO closure of younger patients vs medical therapy. The primary endpoints were the composite outcome of recurrent ischemic neurological events [strok...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
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
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