Patent Foramen Ovale Closure: The Debate Goes On
Keywords:patent foramen ovale, cryptogenic stroke, paradoxical embolism, PFO closure
Meta-analyses of retrospective and case-control studies support an association between a patent foramen ovale (PFO) and “cryptogenic stroke” (stroke without an identifiable cause), especially in young patients (age <55 years). Several reports have also suggested an increased risk of recurrent strokes in patients with PFO. Comparison of the two main strategies to reduce the risk of recurrent stroke in patients with cryptogenic stroke and PFO, antithrombotic therapy vs transcatheter closure of the PFO with a device, has shown PFO closure to confer a lower risk in non-randomized studies, which though has not been confirmed in randomized trials, although a tendency for a lower risk has been indicated, particularly in on-treatment or per-protocol analyses (compared with the intention-to-treat analysis), and appears to be device specific. Thus, PFO closure cannot be presented as the recommended treatment, but it may be offered as an alternative option in select patients, e.g. those with large shunts or with atrial septal aneurysms.
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