Abstract 17143: An Updated Meta Analysis Comparingtranscatheterpatent Foramen Ovale Closure versus Medical Therapy to Prevent Recurrent Cryptogenic Stroke
Background: The closure of patent foramen ovale (PFO) by percutaneous transcatheter approach is controversial in a patient with cryptogenic stroke. Here in, we reviewed the literature and analyzed the data on safety and efficacy of standard medical therapy (MT) compared to mechanical closure by the percutaneous trans-catheter approach after recently published DEFENSE-PFO trial. Hypothesis: Transcatheter PFO closure decreases incidence of recurrent stroke compared to standard MT. Methods: We systematically searched PubMed, SCOPUS and EMBASE for the articles that compared overall mortality, efficacy in preventing recurrent stroke, and transient ischemic attack (TIA) after transcatheter PFO closure compared to standard MT. We also evaluated potential complications such as bleeding and development of atrial fibrillation. Results: A total 6 studies with 3,403 patients met pre-defined inclusion criteria. Mean follow-up was 3.75 years. Overall mortality was indifferent between transcatheter closure compared to MT (RR: 0.74, 95% CI 0.35-1.6, P=0.45, I 2= 0%). However, PFO closure reduced the rate of recurrent stroke by at least 60% (RR: 0.39, 95% CI 0.18-0.82, P=0.01, I 2= 56%), while did not reduce the risk of TIA compared to MT (RR: 0.76, 95% CI 0.52-1.12, P= 0.17, I 2 =0%). Higher incidence of atrial fibrillation was evident in mechanical closure (RR: 4.64, 95% CI 2.37-9.09, p<0.00001, I 2 =11%) but no increase in bleeding (RR: 0.88, 95% CI: 0.4-1.93, p=0.74, I 2 =28%). Conclusions: Mechanical PFO closure by transcatheter approach is a viable option in the prevention of recurrent stroke and TIA with an increased risk of development of atrial fibrillation without the risk of bleeding.