TY - JOUR
T1 - Management of the stroke patient with patent foramen ovale
T2 - New insights and persistent questions in the wake of recent randomized trials
AU - Peña, Jessica M.
AU - Kizer, Jorge R.
N1 - Funding Information:
Acknowledgments Dr. Kizer is supported in part by R01 HL089521 from the National Heart, Lung, and Blood Institute, Bethesda, MD.
PY - 2013/7
Y1 - 2013/7
N2 - Stroke without a known cause, or cryptogenic stroke, accounts for up to 30 % of all ischemic strokes. Paradoxical embolism through a patent foramen ovale (PFO) has been implicated as a potential cause of cryptogenic cerebral ischemia, particularly in young patients. Epidemiological studies have noted an association between PFO and cryptogenic stroke and observational studies have suggested the potential superiority of percutaneous PFO closure over medical therapy. However, until recently, there were no randomized data to test the hypothesis that PFO closure reduces the risk of recurrent cerebral ischemia. The publication of three such trials, all failing to demonstrate a therapeutic advantage for closure over medical therapy in intention-to-treat analyses, provides valuable new data in the field. We review epidemiological evidence linking PFO and stroke and recent observational and randomized trial data evaluating different treatment strategies.
AB - Stroke without a known cause, or cryptogenic stroke, accounts for up to 30 % of all ischemic strokes. Paradoxical embolism through a patent foramen ovale (PFO) has been implicated as a potential cause of cryptogenic cerebral ischemia, particularly in young patients. Epidemiological studies have noted an association between PFO and cryptogenic stroke and observational studies have suggested the potential superiority of percutaneous PFO closure over medical therapy. However, until recently, there were no randomized data to test the hypothesis that PFO closure reduces the risk of recurrent cerebral ischemia. The publication of three such trials, all failing to demonstrate a therapeutic advantage for closure over medical therapy in intention-to-treat analyses, provides valuable new data in the field. We review epidemiological evidence linking PFO and stroke and recent observational and randomized trial data evaluating different treatment strategies.
KW - Cryptogenic stroke
KW - Patent foramen ovale
KW - Transient ischemic attack
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U2 - 10.1007/s11883-013-0338-4
DO - 10.1007/s11883-013-0338-4
M3 - Article
C2 - 23715857
AN - SCOPUS:84878136895
SN - 1523-3804
VL - 15
JO - Current atherosclerosis reports
JF - Current atherosclerosis reports
IS - 7
M1 - 338
ER -