Recent randomised trials will alter management of patent foramen ovale in patients with cryptogenic stroke
Cryptogenic stroke is a devastating event in young patients. Patent foramen ovale (PFO) may be related to this type of stroke in certain cases and can be closed with a percutaneous device. However, due to perceived lack of benefit in early trials, this procedure has not been routinely performed in the past. Guidelines from the American Heart Association and the American Stroke Association published in 2014 state that “for patients with a cryptogenic [ischaemic] stroke or [transient ischaemic attack] and a PFO without evidence for [deep vein thrombosis], available data do not support a benefit for PFO closure”.1 But the results of recent trials and newly revised guidelines recommendations will see a change in landscape.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160–2236.
- 2. Pristipino C, Sievert H, D'Ascenzo F, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EuroIntervention 2019; 14: 1389–1402.
- 3. Li L, Yiin GS, Geraghty OC, et al. Incidence, outcome, risk factors, and long‐term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population‐based study. Lancet Neurol 2015; 14: 903–913.
- 4. Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012; 366: 991–999.
- 5. Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med 2013; 368: 1092–1100.
- 6. Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013; 368: 1083–1091.
- 7. Lee JY, Song JK, Song JM, et al. Association between anatomic features of atrial septal abnormalities obtained by omni‐plane transesophageal echocardiography and stroke recurrence in cryptogenic stroke patients with patent foramen ovale. Am J Cardiol 2010; 106: 129–134.
- 8. Saver JL, Carroll JD, Thaler DE, et al. Long‐term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017; 377: 1022–1032.
- 9. Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017; 377: 1011–1021.
- 10. Søndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 2017; 377: 1033–1042.
- 11. Ahmad Y, Howard JP, Arnold A, et al. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta‐analysis of randomized controlled trials. Eur Heart J 2018; 39: 1638–1649.
- 12. Masoomi R, Tadros P, Wiley M, et al. National trends and outcomes of percutaneous ASD/PFO closure: a report from the national inpatient sample. J Am Coll Cardiol 2018; 71 (Suppl): A1091.
- 13. Kuijpers T, Spencer FA, Siemieniuk RAC, et al. Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke? A clinical practice guideline. BMJ 2018; 362: k2515.
- 14. Wintzer‐Wehekind J, Alperi A, Houde C, et al. Long‐term follow‐up after closure of patent foramen ovale in patients with cryptogenic embolism. J Am Coll Cardiol 2019; 73: 278–287.
No relevant disclosures.