Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Neurological Research and Practice
Published in: Neurological Research and Practice 1/2019

Open Access 01-12-2019 | Stroke | Guidelines

Cryptogenic stroke and patent foramen ovale (abridged and translated version)

Authors: Hans-Christoph Diener, Armin Grau, Stephan Baldus

Published in: Neurological Research and Practice | Issue 1/2019

Login to get access

Abstract

Interventional patent foramen ovale (PFO) closure should be performed in patients aged 16 to 60 years (after extensive neurological and cardiological diagnostic work-up) with a history of cryptogenic ischaemic stroke and patent foramen ovale, with moderate or extensive right-to-left shunt.
In patients with cryptogenic ischaemic stroke and patent foramen ovale, who reject a PFO closure, there is no evidence of superiority of oral anticoagulation over antiplatelet therapy. Therefore, secondary prevention should be performed with aspirin or clopidogrel.
Atrial fibrillation, pericardial tamponade, and pulmonary embolism are reported complications during and after implantation of an occluder. However, these events are so rare that they should not influence the recommendation for implantation.
This article is an abridged and translated version of the guideline published in Nervenarzt: Diener, HC., für die Deutsche Gesellschaft für Neurologie (DGN), Grau, A.J. et al. Nervenarzt (2018) 89: 1143. https://​doi.​org/​10.​1007/​s00115-018-0609-y.
Appendix
Available only for authorised users
Literature
1.
Hart, R. G., Diener, H. C., Coutts, S. B., Easton, J. D., Granger, C. B., O’Donnell, M. J., et al. (2014). Embolic strokes of undetermined source: The case for a new clinical construct. Lancet Neurology, 13(4), 429–438.CrossRef
2.
Lechat, P., Mas, J. L., Lascault, G., Loron, P., Theard, M., Klimczac, M., et al. (1988). Prevalence of patent foramen ovale in patients with stroke. The New England Journal of Medicine, 318(18), 1148–1152.CrossRef
3.
Katsanos, A. H., Spence, J. D., Bogiatzi, C., Parissis, J., Giannopoulos, S., Frogoudaki, A., et al. (2014). Recurrent stroke and patent foramen ovale: A systematic review and metaanalysis. Stroke, 45(11), 3352–3359.CrossRef
4.
Furlan, A. J., Reisman, M., Massaro, J., Mauri, L., Adams, H., Albers, G. W., et al. (2012). Closure o medical therapy for cryptogenic stroke with patent foramen ovale. The New England Journal of Medicine, 366(11), 991–999.CrossRef
5.
Meier, B., Kalesan, B., Mattle, H. P., Khattab, A. A., Hildick-Smith, D., Dudek, D., et al. (2013). Percutaneous closure of patent foramen ovale in cryptogenic embolism. The New England Journal of Medicine, 368(12), 1083–1091.CrossRef
6.
Carroll, J. D., Saver, J. L., Thaler, D. E., Smalling, R. W., Berry, S., MacDonald, L. A., et al. (2013). Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. The New England Journal of Medicine, 368(12), 1092–1100.CrossRef
7.
Mas, J. L., Derumeaux, G., Guillon, B., Massardier, E., Hosseini, H., Mechtouff, L., et al. (2017). Patent foramen Ovale closure or anticoagulation vs. Antiplatelets after stroke. The New England Journal of Medicine, 377(11), 1011–1021.CrossRef
8.
Sondergaard, L., Kasner, S. E., Rhodes, J. F., Andersen, G., Iversen, H. K., Nielsen-Kudsk, J. E., et al. (2017). Patent foramen Ovale closure or antiplatelet therapy for cryptogenic stroke. The New England Journal of Medicine, 377(11), 1033–1042.CrossRef
9.
Saver, J. L., Carroll, J. D., Thaler, D. E., Smalling, R. W., MacDonald, L. A., Marks, D. S., et al. (2017). Long-term outcomes of patent foramen Ovale closure or medical therapy after stroke. The New England Journal of Medicine, 377(11), 1022–1032.CrossRef
10.
Lee, P. H., Song, J. K., Kim, J. S., Heo, R., Lee, S., Kim, D. H., et al. (2018). Cryptogenic stroke and high-risk patent foramen Ovale: The DEFENSE-PFO trial. Journal of the American College of Cardiology, 71(20), 2335–2342.CrossRef
11.
Ntaios, G., Papavasileiou, V., Sagris, D., Makaritsis, K., Vemmos, K., Steiner, T., et al. (2018). Closure of patent foramen ovale versus medical therapy in patients with cryptogenic stroke or transient ischemic attack: Updated systematic review and meta-analysis. Stroke, 49(2), 412–418.
12.
Abo-Salem, E., Chaitman, B., Helmy, T., Boakye, E. A., Alkhawam, H., & Lim, M. (2018). Patent foramen ovale closure versus medical therapy in cases with cryptogenic stroke, meta-analysis of randomized controlled trials. Journal of Neurology, 265(3), 578–585.CrossRef
13.
De Rosa, S., Sievert, H., Sabatino, J., Polimeni, A., Sorrentino, S., & Indolfi, C. (2018). Percutaneous closure versus medical treatment in stroke patients with patent foramen Ovale: A systematic review and meta-analysis. Annals of Internal Medicine, 168(5), 343–350.CrossRef
14.
Shah, R., Nayyar, M., Jovin, I. S., Rashid, A., Bondy, B. R., Fan, T. M., et al. (2018). Device closure versus medical therapy alone for patent foramen ovale in patients with cryptogenic stroke: A systematic review and meta-analysis. Annals of Internal Medicine, 168(5), 335–342.
15.
Ahmad, Y., Howard, J. P., Arnold, A., Shin, M. S., Cook, C., Petraco, R., et al. (2018). Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: A meta-analysis of randomized controlled trials. European Heart Journal, 39(18), 1638–1649.CrossRef
16.
Kent, D. M., Ruthazer, R., Weimar, C., Mas, J. L., Serena, J., Homma, S., et al. (2013). An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology, 81(7), 619–625.CrossRef
17.
Kent, D. M., Dahabreh, I. J., Ruthazer, R., Furlan, A. J., Reisman, M., Carroll, J. D., et al. (2016). Device closure of patent foramen ovale after stroke: Pooled Analysis of Completed Randomized Trials. Journal of the American College of Cardiology, 67(8), 907–917.
18.
Stortecky, S., da Costa, B. R., Mattle, H. P., Carroll, J., Hornung, M., Sievert, H., et al. (2015). Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: A network meta-analysis. European Heart Journal, 36(2), 120–128.CrossRef
19.
Hornung, M., Bertog, S. C., Franke, J., Id, D., Taaffe, M., Wunderlich, N., et al. (2013). Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale. European Heart Journal, 34(43), 3362–3369.CrossRef
20.
Diener, H., Weimar, C., Berlit, P., Deuschl, G., Elger, C., Gold, R., et al. (2012). Leitlinien für Diagnostik und Therapie in der Neurologie. 5. Auflage (p. 1190). Stuttgart: Thieme.
21.
Mir, H., Siemieniuk, R. A. C., Ge, L. C., Foroutan, F., Fralick, M., Syed, T., et al. (2018). Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: A systematic review and network meta-analysis incorporating complementary external evidence. BMJ Open, 8(7), e023761.CrossRef
22.
Wang, T. K. M., Wang, M. T. M., & Ruygrok, P. (2018). Patent foramen Ovale closure versus medical therapy for cryptogenic stroke: Meta-analysis of randomised trials. Heart Lung and Circulation.
23.
Snijder, R. J. R., Suttorp, M. J., Ten Berg, J. M., & Post, M. C. (2018). Percutaneous closure of a patent foramen ovale after cryptogenic stroke. Netherlands Heart Journal, 26(12), 5–12.CrossRef
24.
Saver, J., Mattle, H., & Thaler, D. E. (2018). Patent foramen ovale closure versus medical therapy for cryptogenic ischemic stroke: A topical review. Stroke, 49(6), 1541–1548.CrossRef
Metadata
Title
Cryptogenic stroke and patent foramen ovale (abridged and translated version)
Authors
Hans-Christoph Diener
Armin Grau
Stephan Baldus
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Neurological Research and Practice / Issue 1/2019
Electronic ISSN: 2524-3489
DOI
https://doi.org/10.1186/s42466-019-0008-2

Other articles of this Issue 1/2019

Neurological Research and Practice 1/2019 Go to the issue

Standard operating procedure

Aneurysmatic subarachnoid haemorrhage

Review

General principles and escalation options of immunotherapy in autoantibody-associated disorders of the CNS

Review

Emerging and re-emerging viruses affecting the nervous system

Position statement

Position paper: ability to drive in cerebrovascular diseases

Review

Navigating choice in multiple sclerosis management

Research article

New alternative splicing variants of the ATXN2 transcript