Surgical vs. drug therapy in patients with patent foramen ovale and cryptogenic stroke.

Abstract

OBJECTIVE:

This study aimed to investigate the effectiveness of risk scoring for predicting stroke recurrence after percutaneous patent foramen ovale (PFO) closure or medication therapy in patients with PFO and a history of cryptogenic stroke.

METHODS:

This study included 559 patients with PFO and cryptogenic stroke who were treated in our hospital from January 2013 to January 2018 and were followed up for 15-72 months. After calculating the risk scores for stroke recurrence, we randomly divided the patients into two groups (ratio, 1:1): Patients in one group underwent PFO closure and those in the other received drug therapy.

RESULTS:

Patients in the PFO closure group had a lower risk of recurrent stroke than those in the drug therapy group (1.1% vs. 4.2%). Moreover, serious bleeding was less frequent in the PFO closure group than in the drug therapy group (0% vs. 3.2%), although the incidence of atrial fibrillation or flutter did not significantly differ between the groups (p = 0.67). Interestingly, a subgroup analysis revealed no inter-treatment group difference in the rate of cryptogenic stroke recurrence among patients with risk scores of 0-1. By contrast, PFO closure yielded superior outcomes among patients with risk scores of ≥2.

CONCLUSION:

Compared with drug therapy, PFO closure reduced the risk of recurrent stroke among patients with a risk score of ≥2 and reduced the incidence of serious bleeding without increasing the risk of new-onset atrial fibrillation or atrial flutter.

• Authors: Yunbing Liu, Yi Wu, Lu Xiong
• Journal: Herz (Herz) Vol. 46 Issue 3 Pg. 250-254 (Jun 2021) ISSN: 1615-6692 [Electronic] Germany
• Vernacular Title: Chirurgische vs. medikamentöse Therapie bei Patienten mit offenem Foramen ovale und kryptogenem Schlaganfall.
• PMID: 32394019 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Atrial Fibrillation (diagnosis, drug therapy, epidemiology)
• Foramen Ovale, Patent (complications, drug therapy, surgery)
• Humans
• Ischemic Stroke
• Recurrence
• Secondary Prevention
• Stroke (epidemiology, etiology, prevention & control)