Secondary prevention of cerebrovascular events in patients with patent foramen ovale and cryptogenic stroke: AUSTRIAN-PFO-Registry

Innovative percutaneous procedures for stroke prevention have emerged in the last two decades. Transcatheter closure of the patent foramen ovale (PFO) is performed in patients who suffered a cryptogenic stroke or a transient ischaemic attach (TIA) in order to prevent recurrence of thromboembolic events. Percutaneous occlusion of the left atrial appendage (LAA) has been introduced to reduce stroke risk in patients with atrial fibrillation (AF). The role of PFO and LAA in the occurrence of cerebrovascular events and the interventional device-based therapies to occlude the PFO and LAA are discussed.

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The Role of Patent Foramen Ovale Closure in the Secondary Prevention of Cryptogenic Stroke: a Meta-Analysis Report

International Journal of Cardiovascular Sciences ◽

10.36660/ijcs.20190075 ◽

2019 ◽

Author(s):

Sónia P. Pinto Pereira ◽

Alzira Nunes ◽

Cristina Santos ◽

Scott E. Kasner ◽

José P. L. Nunes

Keyword(s):

Secondary Prevention ◽

Patent Foramen Ovale ◽

Meta Analysis ◽

Cryptogenic Stroke ◽

Foramen Ovale

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Clinical outcomes of secondary prevention strategies for young patients with cryptogenic stroke and patent foramen ovale

Acta Cardiologica ◽

10.1080/00015385.2017.1307668 ◽

2017 ◽

Vol 72 (4) ◽

pp. 410-418 ◽

Cited By ~ 7

Author(s):

Alessandra Danese ◽

Chiara Stegagno ◽

Giampaolo Tomelleri ◽

Anna Piccoli ◽

Giulia Turri ◽

...

Keyword(s):

Secondary Prevention ◽

Clinical Outcomes ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Young Patients ◽

Foramen Ovale ◽

Prevention Strategies

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291 Patent foramen ovale size is still a risk factor for recurrent cerebrovascular events in patients with cryptogenic stroke

European Journal of Echocardiography ◽

10.1016/s1525-2167(03)91072-9 ◽

2003 ◽

Vol 4 ◽

pp. S130

Author(s):

H SCHUCHLENZ ◽

W WEIHS ◽

R SCHMIDT ◽

A LECHNER ◽

A BERGHOLD

Keyword(s):

Risk Factor ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Cerebrovascular Events

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Five Year Follow-Up of Cryptogenic Stroke Patients Following Patent Foramen Ovale Closure

Medical Sciences Forum ◽

10.3390/iecmd2021-10313 ◽

2021 ◽

Vol 6 (1) ◽

pp. 2

Author(s):

Agnete Teivāne ◽

Kristaps Jurjāns ◽

Ainārs Rudzītis ◽

Krista Lazdovska ◽

Artūrs Balodis ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Residual Shunt ◽

Amplatzer Occluder ◽

Cerebrovascular Events ◽

Ischemic Attack ◽

Pfo Closure

Background and Objectives: According to guidelines, patent foramen ovale (PFO) closure is recommended for secondary stroke prevention in patients with cryptogenic stroke. Paradoxial embolism from PFO-mediated right to left shunt has been described as the mechanism of stroke in these cases. The aim of the study was to determine whether PFO closure can be associated with improvement of complaints (headaches, fatigue, heart palpitations, dizziness, and visual impairment) and determine its long-term effectiveness on recurrent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 year, and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: Male patients accounted for 43.7% (n = 45). The mean age was—44.4 ± 13 (18–75). The most probable cause for cryptogenic stroke for 53.4% (n = 55) of patients with possible cardio-aortic embolism was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder—87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patients presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints.

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Abstract 1173: Risk of Recurrent Cerebrovascular Events in Patients with Cryptogenic Cerebral Ischemia and Patent Foramen Ovale: A Meta-Analysis of Observational Studies

Circulation ◽

10.1161/circ.118.suppl_18.s_653 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Stephen B Wilton ◽

Mohammed A Almekhlafi ◽

Doreen M Rabi ◽

William A Ghali ◽

Diane L Lorenzetti ◽

...

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Recurrent Events ◽

Comparison Group ◽

Meta Analysis ◽

Cryptogenic Stroke ◽

Absolute Rate ◽

Foramen Ovale ◽

Cerebrovascular Events ◽

Increased Risk

In patients with a patent foramen ovale (PFO) and a prior cryptogenic ischemic stroke or transient ischemic attack (TIA), the risk of recurrent events is unclear. To conduct a systematic review and meta-analysis of studies assessing the risk of recurrent cerebrovascular events in patients with cryptogenic cerebral ischemia and PFO. MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) databases were searched to identify studies in any language. Searches were supplemented by scanning bibliographies of key articles. Studies reporting original data on recurrent cerebrovascular events in patients with prior cryptogenic stroke or TIA and PFO, with or without a non-PFO comparison group, were included. Uncontrolled case series evaluating device or surgical closure of PFO were excluded. Two authors independently extracted the data from included studies and evaluated study quality. For studies with a non-PFO comparison group, relative risks were pooled using a fixed effects model after confirming homogeneity of results. For all studies, the pooled absolute rate of recurrent events was calculated using a random effects model due to heterogeneity of results. Fifteen studies published between 1994 and 2007, following 2377 patients over a mean of 37 months were included. In the four studies with a non-PFO comparison group, the pooled relative risk of recurrent stroke or TIA associated with the presence of a PFO was 1.1 (95% CI 0.8 to 1.5), while for recurrent ischemic stroke the pooled relative risk associated with the presence of a PFO was 0.8 (95% CI 0.5 to 1.3). The pooled absolute rate of recurrent ischemic stroke or TIA in patients with PFO was 4.0 events per 100 person-years (95% CI 3.0 to 5.1) while the rate of recurrent ischemic stroke was 1.6 events per 100 person years (95% CI 1.1 to 2.1). No clinical or imaging features are reliably associated with increased risk of recurrent events. In medically treated patients with prior cryptogenic stroke, available evidence does not support an increased risk of recurrent ischemic events in those with vs. without a PFO. Routine PFO closure in these patients may not be warranted, outside of ongoing clinical trials.

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