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Farjat-Pasos JI, Guedeney P, Horlick E, Abtan J, Nombela-Franco L, Hibbert B, Sondergaard L, Freixa X, Masson JB, Cruz-González I, Estévez-Loureiro R, Faroux L, Shah AH, Abrahamyan L, Mesnier J, Jerónimo A, Abdel-Razek O, Jørgensen TH, Asmar MA, Sitbon S, Abalhassan M, Robichaud M, Houde C, Côté M, Chamorro A, Lanthier S, Verreault S, Montalescot G, Rodés-Cabau J. Determinants of adverse outcomes following patent foramen ovale closure in elderly patients. EUROINTERVENTION 2024; 20:1029-1038. [PMID: 39155753 PMCID: PMC11317834 DOI: 10.4244/eij-d-24-00156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/26/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly. AIMS Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events. METHODS This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted. RESULTS A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF. CONCLUSIONS Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.
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Affiliation(s)
- Julio I Farjat-Pasos
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
- Pediatric Cardiology Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Eric Horlick
- Cardiology Department, Toronto General Hospital, Toronto, ON, Canada
| | - Jeremie Abtan
- Cardiology Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Benjamin Hibbert
- Cardiology Department, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Lars Sondergaard
- Cardiology Department, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Xavier Freixa
- Cardiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jean-Bernard Masson
- Cardiology Department, University of Montreal Health Centre, Montreal, QC, Canada
| | - Ignacio Cruz-González
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV, Salamanca, Spain
| | | | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Ashish H Shah
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lusine Abrahamyan
- Cardiology Department, Toronto General Hospital, Toronto, ON, Canada
| | - Jules Mesnier
- Cardiology Department, Bichat-Claude-Bernard Hospital, Paris, France
| | - Adrián Jerónimo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Omar Abdel-Razek
- Cardiology Department, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Troels Højsgaard Jørgensen
- Cardiology Department, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mike Al Asmar
- Cardiology Department, University of Montreal Health Centre, Montreal, QC, Canada
| | - Samuel Sitbon
- Cardiology Department, Bichat-Claude-Bernard Hospital, Paris, France
| | | | - Mathieu Robichaud
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
| | - Christine Houde
- Pediatric Cardiology Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Mélanie Côté
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
| | - Angel Chamorro
- Neuroscience Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sylvain Lanthier
- Neurovascular Program and Research Center, Hôpital du Sacré-Coeur-de-Montréal, Montreal, QC, Canada
| | - Steve Verreault
- Neurovascular Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Paris, France
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Québec, QC, Canada
- Pediatric Cardiology Department, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
- Cardiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Voudris KV, Poulin MF, Kavinsky CJ. Updates on Patent Foramen Ovale (PFO) Closure. Curr Cardiol Rep 2024; 26:735-746. [PMID: 38913234 DOI: 10.1007/s11886-024-02073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW Patent foramen ovale (PFO) has been previously linked to left circulation thromboembolism and stroke. This review article aims to discuss the latest evidence, updated societal guidelines, diagnostic algorithms and novel therapeutic devices for PFO closure. RECENT FINDINGS PFO closure for cryptogenic stroke and systemic embolization is supported by a large body of evidence and has a strong societal recommendation. Limited data are available for platypnea-orthodeoxia syndrome, although closure appears to be beneficial. Current data do not support routine closure for migraines and decompression Illness. Development of heart-brain teams can improve identification of patients most likely to benefit from closure, utilizing a combination of imaging test and risk score algorithms. Multiple novel devices aiming at reducing complications and improving the long-term impact of current available devices are being evaluated. PFO closure has significantly progressed over the last years, with new data supporting its superiority in reducing risk of recurrent embolic stroke in patients with PFO-related stroke. Additional clinical data are required to provide further refinements on patient selection and guidance on treatment of specific subgroups.
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Affiliation(s)
- Konstantinos V Voudris
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Marie-France Poulin
- Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Street, Baker 4, Boston, MA, 02215, USA
| | - Clifford J Kavinsky
- Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Street, Baker 4, Boston, MA, 02215, USA.
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Karagianni A, Mandalenakis Z, Papadopoulos S, Dellborg M, Eriksson P. Long-term outcome after closure of an atrial shunt in patients aged 60 years or older with ischemic stroke: A nationwide, registry-based, case-control study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2022.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Goldsweig AM, Batlivala SP, Al-Azizi K, Aggarwal V, Babatunde I, Falck-Ytter Y, Morgan RL. SCAI Technical Review on Management of Patent Foramen Ovale. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100040. [PMID: 39131927 PMCID: PMC11307539 DOI: 10.1016/j.jscai.2022.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Background Patent foramen ovale (PFO) is a common anatomic variant associated with intermittent right-to-left shunting. Transcatheter PFO closure has been proposed to address multiple clinical conditions including stroke, transient ischemic attack, migraine, and decompression illness. Methods A systematic review was conducted using the GRADE approach to address 5 questions formulated by the Society for Cardiovascular Angiography and Interventions (SCAI) Guideline Panel in patient, intervention, comparator, outcome (PICO) format. Medical literature from January 2015 through May 2021 was searched. Extracted data underwent review and risk-of-bias assessment by 2 independent researchers. Pooled effect estimates were calculated. Certainty of evidence was determined for each query. Results Our search identified 2701 titles and abstracts, of which 30 met eligibility criteria and informed the technical review. Data were abstracted to address outcomes of PFO closure for patients with and without prior stroke, in comparison to antiplatelet therapy, in comparison to anticoagulation, and with various post-procedure antithrombotic regimens. Conclusion In appropriately selected patients with prior stroke, transcatheter PFO closure reduces the risk of recurrent stroke more than antiplatelet therapy alone. Evidence to support PFO closure is weaker regarding older patients, anticoagulation, thrombophilia, transient ischemic attack, migraine, and decompression illness. Data from this technical review will inform the SCAI Guideline for Transcatheter Patent Foramen Ovale Closure.
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Affiliation(s)
- Andrew M. Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sarosh P. Batlivala
- Heart Institute, Cincinnati Children's Hospital Medical Center & Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karim Al-Azizi
- Baylor Scott & White Health, The Heart Hospital, Plano, Texas
| | - Vikas Aggarwal
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan (Frankel Cardiovascular Center), Ann Arbor, Michigan
- Section of Cardiology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | - Yngve Falck-Ytter
- Evidence Foundation, Cleveland Heights, Ohio
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
- Case Western University, Cleveland, Ohio
| | - Rebecca L. Morgan
- Evidence Foundation, Cleveland Heights, Ohio
- Case Western University, Cleveland, Ohio
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
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Kavinsky CJ, Szerlip M, Goldsweig AM, Amin Z, Boudoulas KD, Carroll JD, Coylewright M, Elmariah S, MacDonald LA, Shah AP, Spies C, Tobis JM, Messé SR, Senerth E, Falck-Ytter Y, Babatunde I, Morgan RL. SCAI Guidelines for the Management of Patent Foramen Ovale. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100039. [PMID: 39131947 PMCID: PMC11307505 DOI: 10.1016/j.jscai.2022.100039] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Background Patent foramen ovale (PFO) is a vestigial congenital cardiovascular structure present in around 25% of adults. In most cases, PFO is entirely benign and requires no treatment. However, it may cause serious complications under certain circumstances. Objective These evidence-based guidelines from the Society for Cardiovascular Angiography and Interventions (SCAI) aim to support patients, clinicians, and other stakeholders in decisions about management of PFO. Methods SCAI convened a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The Evidence Foundation, a registered 501(c)(3) nonprofit organization, provided methodological support for the guideline-development process. Following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the guideline panel formulated and prioritized clinical questions in population, intervention, comparison, outcome (PICO) format. A separate technical review team of clinical and methodological experts conducted systematic reviews of the evidence, synthesized data, and graded the certainty of the evidence across outcomes. The guideline panel then reconvened to formulate recommendations and supporting remarks informed by the results of the technical review and additional contextual factors described in the GRADE evidence-to-decision framework. Results The panel agreed on 13 recommendations to address variations on 5 clinical scenarios. Conclusions Key recommendations address patient selection for PFO closure in the prevention of recurrent PFO-associated stroke, including populations not commonly included in randomized studies, and scenarios where the PFO closure might serve a role in the prevention of other outcomes such as migraine headaches and decompression illness. The panel has also identified future research priorities to advance the field.
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Affiliation(s)
| | - Molly Szerlip
- Baylor Scott & White The Heart Hospital, Plano, Texas
| | | | - Zahid Amin
- AdventHealth Medical Group, Orlando, Florida
| | | | - John D. Carroll
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | | | | | - Christian Spies
- Sutter Health Palo Alto Medical Foundation, Burlingame, California
| | | | - Steven R. Messé
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Senerth
- Society for Cardiovascular Angiography & Interventions, Washington, DC
| | - Yngve Falck-Ytter
- Case Western Reserve University/VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | | | - Rebecca L. Morgan
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
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Bianco C, Issaurat P, Vallet H. Désaturation et accident vasculaire cérébral chez une patiente âgée aux urgences : quand le foramen s’en mêle ! ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thaler A, Kvernland A, Kelly S, Song C, Aparicio HJ, Mac Grory B, Yaghi S. Stroke Prevention in Patients with Patent Foramen Ovale. Curr Cardiol Rep 2021; 23:183. [PMID: 34718891 DOI: 10.1007/s11886-021-01605-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Patent foramen ovale (PFO) is widely prevalent and studies have suggested an association with ischemic stroke. In this review, we aim to highlight current management of patients with ischemic stroke in the setting of PFO and discuss some areas of controversy. RECENT FINDINGS Upon reviewing the literature, we have found that the evidence regarding the management of patients with cryptogenic stroke and PFO has come a long way in the past several years, and many uncertainties remain in clinical practice. The Risk of Paradoxical Embolism (RoPE) score helps to predict the probability of a pathogenic PFO, and recent trial data confirms the benefit of closure in carefully selected patients. The benefit of closure in older patients and in patients with alternate, competing mechanisms is still uncertain, and the long-term risks of closure are not known. Finally, the efficacy of direct oral anticoagulants (DOACs) in this patient population as compared to other medical therapy or mechanical closure has not yet been investigated. Randomized data is needed to help answer these questions. PFO closure is a safe and effective strategy in reducing stroke risk in carefully selected patients with cryptogenic stroke in the setting of a PFO. More studies are needed to test optimal medical treatment strategies and the safety and efficacy of PFO closure in patient subgroups not included in prior PFO closure trials.
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Affiliation(s)
- Alison Thaler
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexandra Kvernland
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sean Kelly
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Christopher Song
- Department of Internal Medicine, Brown University, Providence, RI, USA
| | - Hugo J Aparicio
- Department of Neurology, Boston University, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | | | - Shadi Yaghi
- Department of Neurology, Brown University, 593 Eddy Street APC 5, Providence, RI, 02903, USA.
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Montoro LC, Ortiz MR, Hurtado NP, Ortega MD, Almodovar AR, Saint-Gerons JMS, Bellido FM, Sepulveda JJO, Moyano RV, Moreno MAR, Alvarez-Ossorio MP, Rubio MDM. Impact on daily clinical practice of the latest evidence on percutaneous closure of patent foramen ovale after cryptogenic stroke: a single-center experience. Neurol Sci 2021; 43:1865-1871. [PMID: 34383161 DOI: 10.1007/s10072-021-05524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES At the end of 2017, three clinical trials demonstrated that, in selected patients, percutaneous closure of patent foramen ovale (PFO) after cryptogenic stroke (CS) reduces the risk of recurrence. Our aim was to determine the impact of these findings on routine clinical practice in a tertiary hospital. METHODS Patients with CS and percutaneous closure of PFO during 2001-2020 were included. The clinical characteristics of the patient and the anatomical characteristics of the foramen were analyzed. Based on both, the closure indications were classified into three groups according to the latest European recommendations and were analyzed in two periods, before and after the publication date of the clinical trials. RESULTS A total of 293 patients were included. The mean age was 49 ± 11 years, and 15% were older than 60 years. The median RoPE score was 6 [p25-75, 5-7] and 75% had complex anatomy (CA). After the publication of the studies, the frequency of CA and the mean age of the patients were significantly higher (89% vs. 69% p < 0.0005 and 51 ± 11 vs. 48 ± 11 years, p = 0.02, respectively), and the RoPE score, significantly lower (5 [5-7] versus 6 [5-7], p = 0.02). Inadequate closure indications were significantly reduced (8% vs. 18%, p = 0.02). CONCLUSION After the publication of clinical trials that have shown benefit of PFO closure after CS, the number of inappropriate indications for closure has decreased significantly in our institution, with a higher percentage of CA, despite a clinical profile suggestive of lower causal probability of PFO.
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Affiliation(s)
- Lucia Carnero Montoro
- Cardiology Service, Reina Sofia University Hospital, Avenue Menendez Pidal s/n, 14004, Cordoba, Spain.
| | - Martin Ruiz Ortiz
- Cardiology Service, Reina Sofia University Hospital, Avenue Menendez Pidal s/n, 14004, Cordoba, Spain
| | - Nick Paredes Hurtado
- Cardiology Service, Reina Sofia University Hospital, Avenue Menendez Pidal s/n, 14004, Cordoba, Spain
| | - Monica Delgado Ortega
- Cardiology Service, Reina Sofia University Hospital, Avenue Menendez Pidal s/n, 14004, Cordoba, Spain
| | - Ana Rodriguez Almodovar
- Cardiology Service, Reina Sofia University Hospital, Avenue Menendez Pidal s/n, 14004, Cordoba, Spain
| | | | | | | | | | | | | | - Maria Dolores Mesa Rubio
- Cardiology Service, Reina Sofia University Hospital, Avenue Menendez Pidal s/n, 14004, Cordoba, Spain
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Eskandari S, Jalali P. Relationship between patent foramen ovale and COVID-19 in patients admitted to an intensive care unit. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:725-726. [PMID: 34030947 PMCID: PMC8096169 DOI: 10.1016/j.rec.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Saber Eskandari
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooya Jalali
- Department of Medicine, Islamic Azad University Tabriz Branch, Tabriz, Iran.
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Eskandari S, Jalali P. [Relationship between patent foramen ovale and COVID-19 in patients admitted to an intensive care unit]. Rev Esp Cardiol 2021; 74:725-726. [PMID: 34092897 PMCID: PMC8166536 DOI: 10.1016/j.recesp.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Saber Eskandari
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Teherán, Irán
| | - Pooya Jalali
- Department of Medicine, Islamic Azad University Tabriz Branch, Teherán, Irán
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ARBOIX A, PARRA O, ALIÓ J. Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke: where are we now? J Geriatr Cardiol 2021; 18:67-74. [PMID: 33613660 PMCID: PMC7868908 DOI: 10.11909/j.issn.1671-5411.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Patent foram ovale (PFO) is the most common anatomical cause of an interarterial shunt. It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults. Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment, six subsequent randomized clinical trials (CLOSURE I, PC Trial, RESPECT, CLOSE, REDUCE, and DEFENSE-PFO) performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure. However, the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO, but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation, as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.
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Affiliation(s)
- Adrià ARBOIX
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Olga PARRA
- Department of Pneumology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Josefina ALIÓ
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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Masjuan J, García-Madrona S, de Felipe A. Cierre del foramen oval permeable en el ictus criptogénico, ¿también en mayores de 60 años? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Masjuan J, García-Madrona S, de Felipe A. Closure of patent foramen ovale in cryptogenic stroke: also in patients older than 60 years? ACTA ACUST UNITED AC 2019; 73:197-199. [PMID: 31882391 DOI: 10.1016/j.rec.2019.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jaime Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain.
| | - Sebastián García-Madrona
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Alicia de Felipe
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
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