Abstract T P134: Size of Patent Foramen Ovale and Recurrent Stroke: A Systematic Review and Meta-Analysis

Background&Purpose: There are contradictory data on the potential association between size of patent foramen ovale (PFO) or coexisting atrial septal aneurysm (ASA) and risk of recurrent stroke. We performed a meta-analysis to evaluate the relationship of PFO size and concomitant ASA with recurrent stroke in medically-treated stroke patients with PFO. Subjects&Methods: We conducted a systematic review and meta-analysis according to PRISMA guidelines of all available prospective studies reporting recurrent cerebrovascular events defined as stroke and/or transient ischemic attacks (TIA) in medically treated patients with PFO diagnosed by echocardiography and/or transcranial Doppler (TCD). Shunt size was stratified according to validated transeosophageal (TEE) or TCD criteria as “small”, “moderate” or “large”. Coexisting ASA was diagnosed using TEE criteria. Results: We identified 6 eligible studies including a total of 1,727 patients. PFO size (large vs. moderate-small PFO) was not associated with a combined higher risk of recurrent stroke/TIA (RR=1.27; 95%CI= 0.52-3.08; p=0.60; Figure, Panel A) or a higher risk of recurrent stroke alone (RR=1.14; 95%CI= 0.56-2.32; p=0.72; Figure, Panel B). Coexisting ASA was not associated with a combiner higher risk of recurrent stroke/TIA (RR=1.63; 95%CI= 0.89-2.98; p=0.11; Figure, Panel C). There was no evidence of heterogeneity for all analyses (I squared statistic < 50%, p > 0.1 Cohran Q test) across the included studies. Conclusions: Our meta-analysis failed to detect any association between PFO-size and risk of recurrent cerebrovascular events in medically-treated stroke patients with PFO. Similarly, the presence of ASA was not related to risk of recurrent cerebral ischemia.