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.
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References and Recommended Reading
- 1.Franson SV: The Botallo mystery. Clin Cardiol 1999, 22:434–436.Google Scholar
- 3.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.Google Scholar
- 5.Cohnheim J: Thrombose und embolie: vorslesung über allgemeine. In Pathologie. Berlin: Hirschwald; 1877:134.Google Scholar
- 9.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.Google Scholar
- 19.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.PubMedCrossRefGoogle Scholar
- 22.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.Google Scholar
- 25.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.Google Scholar
- 26.Homma S, Di Tullio MR, Sacco RL, et al.: Surgical closure of patent foramen ovale in cryptogenic stroke patients. Stroke 1997, 28:2381.Google Scholar