TY - JOUR
T1 - Patent Foramen Ovale Management for Secondary Stroke Prevention
T2 - State-of-the-Art Appraisal of Current Evidence
AU - Sposato, Luciano A.
AU - Albin, Catherine S.W.
AU - Elkind, Mitchell S.V.
AU - Kamel, Hooman
AU - Saver, Jeffrey L.
AU - Goldstein, Larry B.
AU - Das, Alvin S.
AU - Gokcal, Elif
AU - Merino, Jose G.
AU - Broderick, Joseph
AU - Bushnell, Cheryl
AU - Ovbiagele, Bruce
AU - Neisen, Karah B.
AU - Ziegler, Paul D.
AU - Gurol, M. Edip
AU - Selim, Magdy H.
AU - Savitz, Sean I.
AU - Morgan, John R.
N1 - Publisher Copyright:
© 2023 American Heart Association, Inc.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Patent foramen ovale (PFO) is frequently identified in young patients with ischemic stroke. Randomized controlled trials provide robust evidence supporting PFO closure in selected patients with cryptogenic ischemic stroke; however, several questions remain unanswered. This report summarizes current knowledge on the epidemiology of PFO-associated stroke, the role of PFO as a cause of stroke, and anatomic high-risk features. We also comment on breakthrough developments in patient selection algorithms for PFO closure in relation to the PFO-associated stroke causal likelihood risk stratification system. We further highlight areas for future research in PFO-associated stroke including the efficacy and safety of PFO closure in the elderly population, incidence, and long-term consequences of atrial fibrillation post-PFO closure, generalizability of the results of clinical trials in the real world, and the need for assessing the effect of neurocardiology teams on adherence to international recommendations. Other important knowledge gaps such as sex, race/ethnicity, and regional disparities in access to diagnostic technologies, PFO closure devices, and clinical outcomes in the real world are also discussed as priority research topics.
AB - Patent foramen ovale (PFO) is frequently identified in young patients with ischemic stroke. Randomized controlled trials provide robust evidence supporting PFO closure in selected patients with cryptogenic ischemic stroke; however, several questions remain unanswered. This report summarizes current knowledge on the epidemiology of PFO-associated stroke, the role of PFO as a cause of stroke, and anatomic high-risk features. We also comment on breakthrough developments in patient selection algorithms for PFO closure in relation to the PFO-associated stroke causal likelihood risk stratification system. We further highlight areas for future research in PFO-associated stroke including the efficacy and safety of PFO closure in the elderly population, incidence, and long-term consequences of atrial fibrillation post-PFO closure, generalizability of the results of clinical trials in the real world, and the need for assessing the effect of neurocardiology teams on adherence to international recommendations. Other important knowledge gaps such as sex, race/ethnicity, and regional disparities in access to diagnostic technologies, PFO closure devices, and clinical outcomes in the real world are also discussed as priority research topics.
KW - algorithm
KW - atrial fibrillation
KW - ethnicity
KW - ischemic stroke
KW - patent foramen ovale
UR - http://www.scopus.com/inward/record.url?scp=85180979966&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85180979966&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.123.040546
DO - 10.1161/STROKEAHA.123.040546
M3 - Review article
C2 - 38134261
AN - SCOPUS:85180979966
SN - 0039-2499
VL - 55
SP - 236
EP - 247
JO - Stroke
JF - Stroke
IS - 1
ER -