Key result
PFO closure significantly reduced the risk of recurrent stroke compared with medical therapy in patients with cryptogenic stroke (RR 0.42; 95% CI 0.20-0.91; p=0.03).
Why the study?
Does percutaneous PFO closure reduce recurrent strokes in patients with cryptogenic stroke compared to medical therapy?
Meta-Analysis (n=3,440)
Does percutaneous PFO closure reduce recurrent strokes in patients with cryptogenic stroke compared to medical therapy?
Relative Risk: 0.42 (95% CI 0.2–0.91)
p-value: p=0.03
Percutaneous PFO closure significantly reduces the risk of recurrent stroke compared to medical therapy in patients with cryptogenic stroke.
PFO closure reduces recurrent stroke risk in cryptogenic cases; strengthens RCT evidence for updated guidelines in selected patients.
BACKGROUND: Patent foramen ovale (PFO) with atrial septal aneurysm is suggested as an important potential source for cryptogenic strokes. Percutaneous PFO closure to reduce the recurrence of stroke compared to medical therapy has been intensely debated. The aim of this study is to assess whether PFO closure in patients with cryptogenic stroke is safe and effective compared with medical therapy. METHOD: A search of PubMed, Medline, and Cochrane Central Register from January 2000 through September 2017 for randomized controlled trails (RCT), which compared PFO closure to medical therapy in patients with cryptogenic stroke was conducted. We used the items "PFO or patent foramen ovale", "paradoxical embolism", "PFO closure" and "stroke". Data were pooled for the primary outcome measure using the random-effects model as pooled rate ratio (RR). The primary outcome was reduction in recurrent strokes. RESULT: Among 282 studies, 5 were selected. Our analysis included 3,440 patients (mean age 45 years, 55% men, mean follow-up 2.9 years), 1,829 in the PFO closure group and 1,611 in the medical therapy group. The I2 heterogeneity test was found to be 48%. A random effects model combining the results of the included studies demonstrated a statistically significant risk reduction in risk of recurrent stroke in the PFO closure group when compared with medical therapy (RR 0.42; 95% CI 0.20-0.91, p = 0.03). CONCLUSION: Pooled data from 5 large RCTs showed that PFO closure in patients with cryptogenic stroke is safe and effective intervention for prevention of stroke recurrence compared with medical therapy.
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Darmoch et al. (2018) conducted a meta-analysis in cryptogenic stroke (n=3,440). PFO closure vs. medical therapy was evaluated on recurrent strokes (RR 0.42, 95% CI 0.20-0.91, p=0.03). PFO closure significantly reduced the risk of recurrent stroke compared with medical therapy in patients with cryptogenic stroke (RR 0.42; 95% CI 0.20-0.91; p=0.03).
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