The role of device closure of patent foramen ovale in patients with cryptogenic stroke.,Journal of Internal Medicine

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The role of device closure of patent foramen ovale in patients with cryptogenic stroke.
Journal of Internal Medicine ( IF 9.0 ) Pub Date : 2020-08-19 , DOI: 10.1111/joim.13143
M Fukutomi ₁ , B Wilkins ₁ , L Søndergaard ₁

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One of the most frequent causes of cardiac embolism in cryptogenic stroke is a paradoxical embolus, which originate from systemic venous source though an unidentified patent foramen ovale (PFO). PFO is a common finding in the general population with a prevalence of 25% to 30%. Transcatheter PFO device closure is known to be feasible and safety treatment for such patients. In recent years, several randomized controlled trials (RCTs) have been conducted to address the superiority of PFO closure over medical therapy alone in the prevention of stroke recurrence in patients with PFO. In contrast to findings from early 3 RCTs, recent 4 RCTs could successfully show the benefits of PFO device closure compared with medical therapy, with less peri‐ and postprocedural complication. Based on these data, PFO device closure is recommended to carefully select cryptogenic stroke patients aged from 18 to 65 years, with a high probability of a causal role of the PFO in stroke events. However, it is still uncertain whether PFO closure is superior to oral anticoagulants therapy in these patients. Therefore, further prospective randomized trials are needed to address the efficacy of PFO device closure to oral anticoagulants therapy.

中文翻译：

卵圆孔未闭装置的关闭在隐源性中风患者中的作用。

隐源性卒中最常见的心脏栓塞原因之一是自相矛盾的栓塞，其起源于全身静脉来源，但卵圆孔未明（PFO）。PFO是普通人群中的常见发现，患病率为25％至30％。众所周知，经导管PFO装置的闭合对于此类患者是可行且安全的治疗方法。近年来，进行了一些随机对照试验（RCT），以探讨PFO封闭在预防PFO患者中风复发方面优于单纯药物治疗的优势。与早期3项RCT的发现相反，最近4项RCT可以成功显示出PFO装置闭合与药物治疗相比的好处，围手术期和术后并发症更少。根据这些数据，建议关闭PFO设备，以仔细选择年龄在18至65岁之间的隐源性卒中患者，这些患者极有可能在卒中事件中起因。但是，对于这些患者，PFO封闭是否优于口服抗凝治疗尚不确定。因此，需要进一步的前瞻性随机试验来解决PFO装置闭合对口服抗凝治疗的有效性。

更新日期：2020-09-21

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