Practice advisory

Recurrent stroke with patent foramen ovale (update of practice parameter)

Steven R. Messé, Gary Gronseth, David M. Kent, Jorge Kizer, Shunichi Homma, Lee Rosterman, Scott E. Kasner

Research output: Contribution to journalReview article

76 Citations (Scopus)

Abstract

Objective: To update the 2004 American Academy of Neurology guideline for patients with stroke and patent foramen ovale (PFO) by addressing whether (1) percutaneous closure of PFO is superior to medical therapy alone and (2) anticoagulation is superior to antiplatelet therapy for the prevention of recurrent stroke. Methods: Systematic review of the literature and structured formulation of recommendations. Conclusions: Percutaneous PFO closure with the STARFlex device possibly does not provide a benefit in preventing stroke vs medical therapy alone (risk difference [RD] 0.13%, 95% confidence interval [CI] -2.2% to 2.0%). Percutaneous PFO closure with the AMPLATZER PFO Occluder possibly decreases the risk of recurrent stroke (RD -1.68%, 95% CI -3.18% to -0.19%), possibly increases the risk of new-onset atrial fibrillation (AF) (RD 1.64%, 95% CI 0.07%-3.2%), and is highly likely to be associated with a procedural complication risk of 3.4% (95% CI 2.3%-5%). There is insufficient evidence to determine the efficacy of anticoagulation compared with antiplatelet therapy in preventing recurrent stroke (RD 2%, 95% CI -21% to 25%). Recommendations: Clinicians should not routinely offer percutaneous PFO closure to patients with cryptogenic ischemic stroke outside of a research setting (Level R). In rare circumstances, such as recurrent strokes despite adequate medical therapy with no other mechanism identified, clinicians may offer the AMPLATZER PFO Occluder if it is available (Level C). In the absence of another indication for anticoagulation, clinicians may routinely offer antiplatelet medications instead of anticoagulation to patients with cryptogenic stroke and PFO (Level C).

Original languageEnglish (US)
Pages (from-to)815-821
Number of pages7
JournalNeurology
Volume87
Issue number8
DOIs
StatePublished - Aug 23 2016

Fingerprint

Patent Foramen Ovale
Stroke
Confidence Intervals
Therapeutics
Atrial Fibrillation
Guidelines
Equipment and Supplies

ASJC Scopus subject areas

  • Medicine(all)
  • Clinical Neurology

Cite this

Messé, S. R., Gronseth, G., Kent, D. M., Kizer, J., Homma, S., Rosterman, L., & Kasner, S. E. (2016). Practice advisory: Recurrent stroke with patent foramen ovale (update of practice parameter). Neurology, 87(8), 815-821. https://doi.org/10.1212/WNL.0000000000002961

Practice advisory : Recurrent stroke with patent foramen ovale (update of practice parameter). / Messé, Steven R.; Gronseth, Gary; Kent, David M.; Kizer, Jorge; Homma, Shunichi; Rosterman, Lee; Kasner, Scott E.

In: Neurology, Vol. 87, No. 8, 23.08.2016, p. 815-821.

Research output: Contribution to journalReview article

Messé, SR, Gronseth, G, Kent, DM, Kizer, J, Homma, S, Rosterman, L & Kasner, SE 2016, 'Practice advisory: Recurrent stroke with patent foramen ovale (update of practice parameter)', Neurology, vol. 87, no. 8, pp. 815-821. https://doi.org/10.1212/WNL.0000000000002961
Messé, Steven R. ; Gronseth, Gary ; Kent, David M. ; Kizer, Jorge ; Homma, Shunichi ; Rosterman, Lee ; Kasner, Scott E. / Practice advisory : Recurrent stroke with patent foramen ovale (update of practice parameter). In: Neurology. 2016 ; Vol. 87, No. 8. pp. 815-821.
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AU - Rosterman, Lee

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