OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effect of closure of a patent foramen ovale (PFO) compared with medical therapy for the prevention of stroke in patients with prior cryptogenic stroke. BACKGROUND: The role of PFO closure in reducing risk of stroke in patients with prior cryptogenic stroke has been controversial. METHODS: We searched PubMed, Embase, CINAHL, and CENTRAL for randomized trials investigating PFO closure versus medical therapy. We assessed trial bias and the quality of evidence for main outcomes was rated using GRADE. The primary outcome of interest was the occurrence of stroke. Estimates of effect were pooled with a random-effects model. This study is registered with PROSPERO (CRD42017081579). RESULTS: We included five trials, comprising data for 3,440 adults randomized to receive PFO closure (n = 1,829) or medical therapy (n = 1,611). Mean follow-up ranged from 2 years to 5.4 years across the trials. Patients treated with PFO closure had a lower risk of stroke (RR 0.39, 95% CI 0.18-0.88, I2 = 57%, P = 0.02) compared with those treated with medical therapy. Subgroup analyses showed that the beneficial effect of PFO closure on a composite outcome of cerebrovascular events is more pronounced in patients with a large PFO shunt (RR 0.25, 95% CI 0.12-0.54, I2 = 0%, P = 0.0004), male patients (RR 0.34, 95% CI 0.15-0.75, I2 = 36%, P = 0.07), and those aged ≤45 years (RR 0.35, 95% CI 0.15-0.79, I2 = 0%, P = 0.01). CONCLUSIONS: PFO closure reduced risk of stroke compared with medical therapy. PFO closure is a therapeutic option that should be offered to adults with cryptogenic stroke.
OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effect of closure of a patent foramen ovale (PFO) compared with medical therapy for the prevention of stroke in patients with prior cryptogenic stroke. BACKGROUND: The role of PFO closure in reducing risk of stroke in patients with prior cryptogenic stroke has been controversial. METHODS: We searched PubMed, Embase, CINAHL, and CENTRAL for randomized trials investigating PFO closure versus medical therapy. We assessed trial bias and the quality of evidence for main outcomes was rated using GRADE. The primary outcome of interest was the occurrence of stroke. Estimates of effect were pooled with a random-effects model. This study is registered with PROSPERO (CRD42017081579). RESULTS: We included five trials, comprising data for 3,440 adults randomized to receive PFO closure (n = 1,829) or medical therapy (n = 1,611). Mean follow-up ranged from 2 years to 5.4 years across the trials. Patients treated with PFO closure had a lower risk of stroke (RR 0.39, 95% CI 0.18-0.88, I2 = 57%, P = 0.02) compared with those treated with medical therapy. Subgroup analyses showed that the beneficial effect of PFO closure on a composite outcome of cerebrovascular events is more pronounced in patients with a large PFO shunt (RR 0.25, 95% CI 0.12-0.54, I2 = 0%, P = 0.0004), male patients (RR 0.34, 95% CI 0.15-0.75, I2 = 36%, P = 0.07), and those aged ≤45 years (RR 0.35, 95% CI 0.15-0.79, I2 = 0%, P = 0.01). CONCLUSIONS: PFO closure reduced risk of stroke compared with medical therapy. PFO closure is a therapeutic option that should be offered to adults with cryptogenic stroke.
Authors: Michel Pompeu Barros Oliveira Sá; Erik Everton Silva Vieira; Luiz Rafael Pereira Cavalcanti; Roberto Gouveia Silva Diniz; Sérgio da Costa Rayol; Alexandre Motta de Menezes; Ricardo Felipe de Albuquerque Lins; Ricardo Carvalho Lima Journal: Braz J Cardiovasc Surg Date: 2018 Sep-Oct
Authors: Frank C Barone; Cezary Marcinkiewicz; Jie Li; Yi Feng; Mark Sternberg; Peter I Lelkes; David Rosenbaum-Halevi; Jonathan A Gerstenhaber; Giora Z Feuerstein Journal: Int J Nanomedicine Date: 2019-02-14
Authors: Simona Sperlongano; Mario Giordano; Giovanni Ciccarelli; Giuseppe Bassi; Marco Malvezzi Caracciolo D'Aquino; Carmen Del Giudice; Gianpiero Gaio; Antonello D'Andrea; Adriana Postolache; Maurizio Cappelli Bigazzi; Giancarlo Scognamiglio; Berardo Sarubbi; Maria Giovanna Russo; Paolo Golino; Patrizio Lancellotti Journal: J Clin Med Date: 2022-07-11 Impact factor: 4.964