Is Patent Foramen Ovale Closure More Effective Than Medical Therapy in Preventing Stroke Recurrence in Patients With Cryptogenic Stroke?: A Critically Appraised Topic

The Neurologist
Cristina Valencia-SanchezCumara B O'Carroll

Abstract

The clinical benefit of patent foramen ovale (PFO) closure in patients with cryptogenic stroke (CS) for recurrent stroke prevention has been a subject of extensive debate. Prior clinical trials failed to show superiority of PFO closure versus medical therapy. Meta-analyses suggested a possible benefit of PFO closure in select patients. The objective of this study was to critically assess current evidence regarding the efficacy of PFO closure compared with medical therapy for recurrent stroke prevention in patients with CS. The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, medical librarian, and vascular neurology and interventional cardiology content experts. A randomized, controlled trial was selected for critical appraisal. This trial compared the efficacy of PFO closure and medical therapy in recurrent stroke prevention. A total of 663 patients who had a recent CS attributed to PFO, with a large interatrial shunt or with an associated atrial septal...Continue Reading

References

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
Mar 22, 2014·Lancet Neurology·Robert G HartUNKNOWN Cryptogenic Stroke/ESUS International Working Group
May 3, 2014·Stroke; a Journal of Cerebral Circulation·Walter N KernanUNKNOWN American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and
Feb 27, 2016·Journal of the American College of Cardiology·David M KentDavid E Thaler
Jun 24, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Yee-Ping Sun, Shunichi Homma
Feb 6, 2017·Continuum : Lifelong Learning in Neurology·Cumara B O'Carroll, Kevin M Barrett
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·Allan H Ropper
Sep 14, 2017·The New England Journal of Medicine·Jean-Louis MasUNKNOWN CLOSE Investigators

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Citations

Nov 26, 2021·Aerospace Medicine and Human Performance·Mark E Lytle, Bryant R Martin

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Methods Mentioned

BETA
sedation

Software Mentioned

REDUCE
CLOSE
CLOSURE
RESPECT
Ovid

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