Haris Riaz1, Muhammad Shahzeb Khan2, Aldo L Schenone1, Anam A Waheed3, Arooj Razzak Khan4, Richard A Krasuski5. 1. Department of Cardiovascular Medicine, Cleveland Clinic, OH. 2. John H. Stroger Jr Hospital of Cook County, Chicago, IL. 3. Department of Internal Medicine, University of Pittsburgh Medical Center, PA. 4. Department of Internal Medicine, Cleveland Clinic, OH. 5. Duke University Medical Center, Durham, NC. Electronic address: richard.krasuski@duke.edu.
Abstract
BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) after cryptogenic stroke has long been a contentious issue. Herein, we pool aggregate data examining safety and efficacy of transcatheter closure of PFO compared with medical therapy following initial cryptogenic stroke. METHODS: We searched for randomized clinical trials (RCT) that compared device closure with medical management and reported on subsequent stroke and adverse events. Stroke was considered as the primary efficacy endpoint, whereas bleeding and atrial fibrillation were considered primary safety endpoints. Data were pooled by the random effects model and I2 was used to assess heterogeneity. RESULTS: A total of 5 RCT investigating 3630 patients met inclusion criteria. Pooled analysis revealed that device closure compared to medical management was associated with a significant reduction in stroke (RR=0.3, 95% CI=0.02-0.57). There was, however, a significant increase in atrial arrhythmias with device therapy (RR=4.8, 95% CI=2.2-10.7). We found no increase in bleeding (RR=0.80, 95% CI=0.5-1.4), death (RR=0.76, 95% CI=0.3-1.99) or "any adverse events" (RR=1.02, 95% CI=0.85-1.23) with device therapy. Sub-group analysis revealed that device closure significantly reduced the incidence of the composite primary endpoint among patients who had moderate to large shunt sizes (RR=0.22, 95% CI=0.02-0.42). CONCLUSIONS: Transcatheter closure is associated with a significant reduction in the risk of stroke compared to medical management at the expense of an increased risk of atrial arrhythmias.
BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) after cryptogenic stroke has long been a contentious issue. Herein, we pool aggregate data examining safety and efficacy of transcatheter closure of PFO compared with medical therapy following initial cryptogenic stroke. METHODS: We searched for randomized clinical trials (RCT) that compared device closure with medical management and reported on subsequent stroke and adverse events. Stroke was considered as the primary efficacy endpoint, whereas bleeding and atrial fibrillation were considered primary safety endpoints. Data were pooled by the random effects model and I2 was used to assess heterogeneity. RESULTS: A total of 5 RCT investigating 3630 patients met inclusion criteria. Pooled analysis revealed that device closure compared to medical management was associated with a significant reduction in stroke (RR=0.3, 95% CI=0.02-0.57). There was, however, a significant increase in atrial arrhythmias with device therapy (RR=4.8, 95% CI=2.2-10.7). We found no increase in bleeding (RR=0.80, 95% CI=0.5-1.4), death (RR=0.76, 95% CI=0.3-1.99) or "any adverse events" (RR=1.02, 95% CI=0.85-1.23) with device therapy. Sub-group analysis revealed that device closure significantly reduced the incidence of the composite primary endpoint among patients who had moderate to large shunt sizes (RR=0.22, 95% CI=0.02-0.42). CONCLUSIONS: Transcatheter closure is associated with a significant reduction in the risk of stroke compared to medical management at the expense of an increased risk of atrial arrhythmias.
Authors: Scott E Kasner; Balakumar Swaminathan; Pablo Lavados; Mukul Sharma; Keith Muir; Roland Veltkamp; Sebastian F Ameriso; Matthias Endres; Helmi Lutsep; Steven R Messé; J David Spence; Krassen Nedeltechev; Kanjana Perera; Gustavo Santo; Veronica Olavarria; Arne Lindgren; Shrikant Bangdiwala; Ashkan Shoamanesh; Scott D Berkowitz; Hardi Mundl; Stuart J Connolly; Robert G Hart Journal: Lancet Neurol Date: 2018-09-28 Impact factor: 44.182
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