Closure of patent foramen ovale in "cryptogenic" stroke: Has the story come to an end?

International Journal of Stroke : Official Journal of the International Stroke Society
Jean-Louis Mas, Gilles Chatellier

Abstract

Contrasting with three randomized trials that failed to show any superiority of patent foramen ovale closure over antithrombotic therapy, two trials recently reported lower rates of stroke recurrence among patients assigned to patent foramen ovale closure than among those assigned to antiplatelet therapy. In addition, one of the initially negative trials concluded in favor of patent foramen ovale closure after an extended follow-up period. A better selection of patients, the use of reference treatment groups that included patients who received antiplatelet therapy alone (rather than antiplatelet drugs or oral anticoagulants, according to physician preference), and a longer follow-up of patients, may explain the divergent findings across studies. Procedural complications were reported in 1.5% to 5.9% of the patients, none of which led to permanent disability or death. Patent foramen ovale closure was associated with an increased risk of new-onset atrial fibrillation in several studies and of venous thromboembolism in one study.

References

May 5, 1988·The New England Journal of Medicine·P LechatY Grosgogeat
Dec 14, 2001·The New England Journal of Medicine·J L MasUNKNOWN Patent Foramen Ovale and Atrial Septal Aneurysm Study Group
May 16, 2009·Stroke; a Journal of Cerebral Circulation·Alawi A Alsheikh-AliDavid M Kent
Mar 16, 2012·The New England Journal of Medicine·Anthony J FurlanUNKNOWN CLOSURE I Investigators
Mar 22, 2013·The New England Journal of Medicine·Bernhard MeierUNKNOWN PC Trial Investigators
Mar 22, 2013·The New England Journal of Medicine·John D CarrollUNKNOWN RESPECT Investigators
Sep 14, 2017·The New England Journal of Medicine·Lars SøndergaardUNKNOWN Gore REDUCE Clinical Study Investigators
Sep 14, 2017·The New England Journal of Medicine·Jeffrey L SaverUNKNOWN RESPECT Investigators
Sep 14, 2017·The New England Journal of Medicine·Jean-Louis MasUNKNOWN CLOSE Investigators

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Citations

Apr 9, 2019·European Heart Journal·Mohamad AlkhouliDavid R Holmes
Jan 27, 2019·Journal of the American College of Cardiology·Jérôme Wintzer-WehekindJosep Rodés-Cabau

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