Percutaneous Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale A Systematic Review and Meta-analysis

被引:59
作者
De Rosa, Salvatore [1 ]
Sievert, Horst [2 ]
Sabatino, Jolanda [1 ]
Polimeni, Alberto [1 ]
Sorrentino, Sabato [1 ]
Indolfi, Ciro [1 ]
机构
[1] Magna Graecia Univ Catanzaro, Dept Med & Surg Sci, Div Cardiol, Viale Europa S-N, I-88100 Catanzaro, CZ, Italy
[2] Cardiovasc Ctr Frankfurt CVC, Seckbacher Landstr 65, D-60389 Frankfurt, Germany
关键词
TRANSIENT ISCHEMIC ATTACK; CRYPTOGENIC STROKE; RECURRENT STROKE; CLINICAL-TRIALS; THERAPY; GUIDELINE; SIZE; ADD;
D O I
10.7326/M17-3033
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: New evidence emerged recently regarding the percutaneous closure of patent foramen ovale (PFO) to prevent recurrent stroke in patients with cryptogenic stroke. Purpose: To compare risks for recurrent cerebrovascular events in adults with PFO and cryptogenic stroke who underwent PFO closure versus those who received medical therapy alone. Data Sources: PubMed, Scopus, and Google Scholar from 1 December 2004 through 14 September 2017; references of eligible studies; relevant scientific session abstracts; and cardiology Web sites. Study Selection: Randomized controlled trials, published in English, that compared PFO closure using a currently available device with medical treatment alone and that reported, at minimum, the rates of stroke or transient ischemic attack (TIA) or of new-onset atrial fibrillation (AF) or atrial flutter (AFL). Data Extraction: 2 investigators independently extracted study data and assessed study quality. Data Synthesis: 4 of 5 trials comparing PFO closure with medical therapy used commercially available devices. These 4 trials, involving 2531 patients, found that PFO closure reduced the risk for the main outcome of stroke or TIA (risk difference [RD], -0.029 [95% CI, -0.050 to -0.007]) and increased the risk for new-onset AF or AFL (RD, 0.033 [CI, 0.012 to 0.054]). The beneficial effect of PFO closure was associated with larger interatrial shunts (P = 0.034). Limitation: Trials were not double-blind, and inclusion criteria were heterogeneous. Conclusion: Compared with medical treatment, PFO closure prevents recurrent stroke and TIA but increases the incidence of AF or AFL in PFO carriers with cryptogenic stroke.
引用
收藏
页码:343 / +
页数:11
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