Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke: where are we now?

Adrià ARBOIX; Olga PARRA; Josefina ALIÓ

doi:10.11909/j.issn.1671-5411.2021.01.009

Volume 18 Issue 1

Feb. 2021

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Article Navigation > Journal of Geriatric Cardiology > 2021 > 18(1): 67-74

Please cite this article as: ARBOIX A, PARRA O, ALIÓ J. Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke: where are we now? J Geriatr Cardiol 2021; 18(1): 67−74. DOI: 10.11909/j.issn.1671-5411.2021.01.009

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Please cite this article as: ARBOIX A, PARRA O, ALIÓ J. Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke: where are we now? J Geriatr Cardiol 2021; 18(1): 67−74. DOI: 10.11909/j.issn.1671-5411.2021.01.009

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Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke: where are we now?

doi: 10.11909/j.issn.1671-5411.2021.01.009

1.
Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
2.
Department of Pneumology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
3.
Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain

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Corresponding author: aarboix@quironsalud.org
Available Online: 2021-02-07
Publish Date: 2021-02-07

Abstract

Abstract

Patent foram ovale (PFO) is the most common anatomical cause of an interarterial shunt. It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults. Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment, six subsequent randomized clinical trials (CLOSURE I, PC Trial, RESPECT, CLOSE, REDUCE, and DEFENSE-PFO) performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure. However, the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO, but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation, as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.
- Cryptogenic stroke,
- Ischemic stroke,
- Patent foramen ovale,
- PFO closure,
- Stroke recurrence

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References(35)

References

[1]	Serena J, Dávalos A. Patent foramen ovale and cryptogenic stroke: where do we go from here. Rev Esp Cardiol 2003; 56: 649−651. doi: 10.1157/13049644
[2]	Kamel H. The evolving concept of cryptogenic stroke. Continuum (Minneap Minn) 2020; 26: 353−362.
[3]	Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Front Neurol 202; 11: 281.
[4]	Miranda B, Fonseca AC, Ferro JM. Patent foramen ovale and stroke. J Neurol 2018; 265: 1943−1949. doi: 10.1007/s00415-018-8865-0
[5]	Xu L, Pan X, Zhou Ch, Li J, Wang F. Long-term efficacy after closure of patent foramen ovale for ischemic neurological events in young adults: a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99: e18675. doi: 10.1097/MD.0000000000018675
[6]	Arboix A, Alvarez-Sabin J, Soler L. Stroke. Classification and diagnostic criteria. Ad hoc Editorial Committee of the Task Force on Cerebrovascular Diseases of SEN. [Article in Spanish]. Neurologia 1998; 13(Suppl 3): S3−S10.
[7]	Arboix A. Cardiovascular risk factors for acute stroke: risk profiles in the different suptypes of ischemic stroke. Word J Clin Cases 2015; 3: 418−429. doi: 10.12998/wjcc.v3.i5.418
[8]	Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Eng J Med 2014; 370: 2478−2486. doi: 10.1056/NEJMoa1313600
[9]	Arboix A, Alió J. Acute cardioembolic stroke: an update. Expert Rev Cardiovasc Ther 2011; 9: 367−379. doi: 10.1586/erc.10.192
[10]	Iadecola C, Parikh NS. Blood pressure ups and downs foreshadow cerebral microangiopaty. J Am Coll Cardiol 2020; 75: 2400−2402.
[11]	Arboix A, Jiménez C, Massons J, Parra O, Besses C. Hematological disorders: a commonly unrecognized cause of acute stroke. Expert Rev Hematol 2016; 9: 891−901. doi: 10.1080/17474086.2016.1208555
[12]	Alkhouli M, Sievert H, Holmes DR. Patent foramen ovale closure for secondary stroke prevention. Eur Heart J 2019; 40: 2339−2350. doi: 10.1093/eurheartj/ehz157
[13]	Favilla CG, Messé SR. Patent foramen ovale and stroke: current evidence and treatment options. Curr Opin Neurol 2020; 33: 10−16. doi: 10.1097/WCO.0000000000000782
[14]	Alakbarzade V, Keteepe-Arachi T, Karsan N, Ray R, Pereira AC. Patent foramen ovale. Pract Neurol 2019; 20: 75−79.
[15]	Furlan AJ, Reisman M, Massaro J, Nauri L, Adams H, Albers GW. Closure or medical theraphy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012; 366: 991−999. doi: 10.1056/NEJMoa1009639
[16]	Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013; 368: 1083−1091. doi: 10.1056/NEJMoa1211716
[17]	Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017; 377: 1022−1032. doi: 10.1056/NEJMoa1610057
[18]	Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017; 377: 1011−1021. doi: 10.1056/NEJMoa1705915
[19]	Søndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Eng J Med 2017; 377: 1033−1042. doi: 10.1056/NEJMoa1707404
[20]	Lee PH, Song JK, Kim JS, et al. Cryptogenic stroke at high-risk patent foramen ovale: The DEFENSE-PFO Trial. J Am Coll Cardiol 2018; 71: 2335−2342. doi: 10.1016/j.jacc.2018.02.046
[21]	Safouris A, Kargiotis O, Psychogios K, et al. A narrative and critical review of randomized-controlled clinical trials on patent foramen ovale closure for reducing the risk of stroke recurrence. Font Neurol 2020; 11: 434.
[22]	Maida CD, Norrito RL, Daidone M, Tuttolomondo A, Pinto A. Neuroinflammatory mechanisms in ischemic stroke: focus on cardioembolic stroke, background, and therapeutic approaches. Int J Mol Sci 2020; 21: 6454. doi: 10.3390/ijms21186454
[23]	Chen Y, Pu J, Liu Y, et al. Pro-inflammatory cytokines are associated with the development of post-stroke depression in the acute stage of stroke: a meta-analysis. Top Stroke Rehabil 2020; 27(8): 620−629. doi: 10.1080/10749357.2020.1755813
[24]	Messé SR, Gronseth GS, Kent DM, et al. Practice advisory update summary: Patent foramen ovale and secondary stroke prevention: Report of the Guideline Subcommittee of the American Academy of Neurology. Neurology 2020; 94: 876−885. doi: 10.1212/WNL.0000000000009443
[25]	Arboix A, García-Eroles L, Massons J, Oliveres M. Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction. Cerebrovasc Dis 1998; 8: 8−13.
[26]	Favilla CG, Ingala E, Jara J, et al. Predictors of finding occult atrial fibrillation after cryptogenic stroke. Stroke 2015; 46: 1210−1215. doi: 10.1161/STROKEAHA.114.007763
[27]	Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014; 370: 2467−2477. doi: 10.1056/NEJMoa1311376
[28]	Arboix A, Font A, Garro C, et al. Recurrent lacunar infarction following a previous lacunar stroke: a clinical study of 122 patients. J Neurol Neurosurg Psychiatry 2007; 78: 1392−1394. doi: 10.1136/jnnp.2007.119776
[29]	Arboix A, Blanco-Rojas L, Martí-Vilalta JL. Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies. Expert Rev Neurother 2014; 14: 261−276. doi: 10.1586/14737175.2014.884926
[30]	Elgendy AY, Saber JL, Amin Z. Proposal for updated nomenclature and classification of potential causative mechanism in patent foramen ovale-associated stroke. JAMA Neurol 2020; 77: 878−886. doi: 10.1001/jamaneurol.2020.0458
[31]	Karagianni A, Mandalenakis Z, Dellborg M, Mirzada N, Johansson MC, Eriksson P. Recurrent cerebrovascular events in patients after percutaneous closure of patent foramen ovale. J Stroke Cerebrovasc Dis 2020; 29: 104860. doi: 10.1016/j.jstrokecerebrovasdis.2020.104860
[32]	Masjuan J, García-Madrona S, de Felipe A. Closure of patent foramen ovale in cryptogenic stroke: also in patients older than 60 years? Rev Esp Cardiol (Engl Ed) 2020; 73: 197−199. doi: 10.1016/j.recesp.2019.09.021
[33]	Wintzer-EWehekind J, Alperi A, Houde C, et al. Transcatheter closure of patent foramen ovale in patients older than 60 years of age with cryptogenic embolism. Rev Esp Cardiol (Engl Ed) 2020; 73: 219−224. doi: 10.1016/j.recesp.2019.07.009
[34]	Carbajo-García AM, Cortés J, Arboix A, et al. Predictive clinical features of cardioembolic infarction in patients aged 85 years and older. J Geriatr Cardiol 2019; 16: 793−799.
[35]	Mehlum MH, Liestøl K, Kjeldsen SE, et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. Eur Heart J 2018; 39: 2243−2251. doi: 10.1093/eurheartj/ehx760