Management of patients with stroke and a patent foramen ovale
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Observational studies have established a strong association between the presence of patent foramen ovale (PFO) and increased risk of ischemic stroke. The mechanism involved is presumed to be a paradoxical embolism from a venous thrombus that travels via the PFO to the systemic circulation. The best treatment modality to prevent recurrent stroke in patients with PFO remains undefined. There are four major choices: 1) medical therapy with anticoagulants, 2) medical therapy with antiplatelet agents, 3) surgical closure, and 4) percutaneous device closure. The Patent Foramen Ovale in Cryptogenic Stroke Study has demonstrated that antiplatelet and anticoagulant therapies are of equal benefit in preventing recurrent neurologic events in stroke patients with a PFO. Medical therapy should remain as the initial choice of secondary prophylactic therapy. PFO closure, either surgical or percutaneous, may further reduce event rates; however, this remains to be demonstrated because no randomized trial to date has compared PFO closure with medical therapy.
- Franson SV: The Botallo mystery. Clin Cardiol 1999, 22:434–436.
- Hagen PT, Scholz DG, Edwards WD: Incidence and size of PFO during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984, 59:17–20.
- Homma S, Di Tullio MR, Sacco RL: Patent foramen ovale and ischemic stroke. In Stroke: Pathophysiology, Diagnosis, and Management. Edited by Barnett HJ, Stein BM. Boston: Churchill Livingstone; 1998:1013–1024.
- Meissner I, Whinant JP, Khandheria BK, et al.: Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC Study. Mayo Clin Proc 1999, 74:862–869. CrossRef
- Cohnheim J: Thrombose und embolie: vorslesung über allgemeine. In Pathologie. Berlin: Hirschwald; 1877:134.
- Webster MW, Chancellor AM, Smith HJ, et al.: Patent foramen ovale in young stroke patients. Lancet 1988, 2:11–12. CrossRef
- Lechat P, Mas JL, Lescault G, et al.: Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988, 318:1148–1152. CrossRef
- Di Tullio MR, Sacco RL, Gopal A, et al.: Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1992, 117:461–465.
- Massaro AR, Hoffman M, Sacco RL, et al.: Detection of paradoxical cerebral embolism using transcranial Doppler in a patient with infarct of undetermined cause. Cerebrovasc Dis 1993, 3:116–119.
- Di Tullio MR, Sacco RL, Venketasubramanian N, et al.: Comparison of diagnostic techniques for the detection of a PFO in stroke patients. Stroke 1993, 24:1020–1024.
- Homma S, Di Tullio MR, Sacco RL, et al.: Characteristics of patent foramen ovale associated with cryptogenic stroke, a biplane transesophageal echocardiographic study. Stroke 1994, 25:582–586.
- Steiner MM, Di Tullio MR, Rundek T, et al.: Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke 1998, 29:944–948.
- Hanna JP, Sun JP, Furlan AJ, et al.: Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention. Stroke 1994, 25:782–786.
- Hausman D, Mugge A, Daniel WG: Identification of patent foramen ovale permitting paradoxical embolism. J Am Coll Cardiol 1995, 26:1030–1038. CrossRef
- Mas JL, Zuber M: Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. French Study Group on Patent Foramen Ovale and Atrial Septal Aneurysm. Am Heart J 1995, 140:1083–1088. CrossRef
- Bogousslavsky J, Garazi S, Jeanrenaud X, et al.: Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stoke with Paradoxical Embolism Study Group. Neurology 1996, 46:1301–1305.
- Cujec B, Mainra R, Johnson DH: Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. Can J Cardiol 1999, 15:57–64.
- Mas JL, Arquizan C, Lamy C, et al., for the Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001, 345:1740–1746. CrossRef
- Homma S, Sacco RL, Di Tullio MR, et al., for the PICSS Investigators: Effect of medical treatment in stroke patients with PFO: PFO in Cryptogenic Stroke study. Circulation 2002, 105:2625–2631. First randomized clinical trial comparing anticoagulant with antiplatelet therapy for secondary stroke prevention among patients with PFO. CrossRef
- Pastorek JS, Allen HD, Davis JT: Current outcomes of surgical closure of secundum atrial septal defects. Am J Cardiol 1994, 74:75–77. CrossRef
- Harvey JR, Teague SM, Anderson JL, et al.: Clinically silent atrial septal defects with evidence for cerebral embolism. Ann Intern Med 1986, 105:695–697.
- Zhu WX, Khandheria BK, Warnes CA, et al.: Closure of patent foramen ovale for cryptogenic stroke in young patients: longterm follow-up [abstract]. Circulation 1992, 86:I-497.
- Ruchat P, Bogousslavsky J, Hurni M, et al.: Systematic surgical closure of patent foramen ovale in selected patients with cerebrovascular events due to paradoxical embolism. Early results of a preliminary study. Eur J Cardiothorac Surg 1997, 11:824–827. CrossRef
- Devuyst G, Bogousslavsky J, Ruchat P, et al.: Prognosis after stroke followed by surgical closure of patent foramen ovale: a prospective follow-up study with brain MRI and simultaneous transesophageal and transcranial Doppler ultrasound. Neurology 1996, 47:1162–1166.
- Deriani JA, Urgulu BS, Danielson GK, et al.: Surgical patent foramen ovale closure for prevention of the paradoxical embolism-related cerebrovascular ischemic events. Circulation 1999, 100:II171-II 175.
- Homma S, Di Tullio MR, Sacco RL, et al.: Surgical closure of patent foramen ovale in cryptogenic stroke patients. Stroke 1997, 28:2381.
- Argenziano M, Oz MC, DeRose JJ Jr, et al.: Totally endoscopic atrial septal defect repair with robotic assistance. Heart Surg Forum 2002, 5:294–300.
- Bridges ND, Hellenbrand W, Latson L, et al.: Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation 1992, 86:1902–1908.
- Windecker S, Wahl A, Chatterjee T, et al.: Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long term risk of recurrent thromboembolic events. Circulation 2000, 101:893–898.
- Hung J, Landzberg MJ, Jenkins KJ, et al.: Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol 2000, 35:1311–1316. CrossRef
- Braun MU, Fassbender D, Schoen SP, et al.: Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 2002, 39:2019–2025. CrossRef
- Martin F, Sanchez PL, Doherty E, et al.: Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. Circulation 2002, 106:1121. The most recent study of percutaneous PFO closure. CrossRef
- Rodriguez C, Di Tullio MR, Sacco RL, Homma S: Intra-atrial thrombus in a patient following surgical PFO closure. J Am Soc Echocardiogr 2001, 14:63–66. CrossRef
- Management of patients with stroke and a patent foramen ovale
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