JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2004; 44:750-758, doi:10.1016/j.jacc.2004.05.044
© 2004 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Windecker, S.
Right arrow Articles by Meier, B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Windecker, S.
Right arrow Articles by Meier, B.

CLINICAL RESEARCH: CLINICAL TRIALS

Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke

Stephan Windecker, MD*,*, Andreas Wahl, MD*, Krassen Nedeltchev, MD{dagger}, Marcel Arnold, MD{dagger}, Markus Schwerzmann, MD*, Christian Seiler, MD, FACC*, Heinrich P. Mattle, MD{dagger} and Bernhard Meier, MD, FACC*,*

* Cardiology
{dagger} Neurology, University Hospital, Bern,Switzerland

Manuscript received September 7, 2003; revised manuscript received May 9, 2004, accepted May 11, 2004.

* Reprint requests and correspondence: Dr. Stephan Windecker, Director of Invasive Cardiology, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland (Email: stephan.windecker{at}insel.ch).

OBJECTIVES: The purpose of this study was to compare the efficacy of medical treatment with percutaneous closure of patent foramen ovale (PFO).

BACKGROUND: Patients with cryptogenic stroke and PFO are at risk for recurrent cerebrovascular events.

METHODS: We compared the risk of recurrence in 308 patients with cryptogenic stroke and PFO, who were treated either medically (158 patients) or underwent percutaneous PFO closure (150 patients) between 1994 and 2000.

RESULTS: Patients undergoing percutaneous PFO closure had a larger right-to-left shunt (p < 0.001; 95% confidence interval [CI] 1.38 to 3.07) and were more likely to have suffered more than one cerebrovascular event (p = 0.03; 95% CI 1.04 to 2.71). At four years of follow-up, percutaneous PFO closure resulted in a non-significant trend toward risk reduction of death, stroke, or transient ischemic attack (TIA) combined (8.5% vs. 24.3%; p = 0.05; 95% CI 0.23 to 1.01), and of recurrent stroke or TIA (7.8% vs. 22.2%; p = 0.08; 95% CI 0.23 to 1.11) compared with medical treatment. Patients with more than one cerebrovascular event at baseline and those with complete occlusion of PFO were at lower risk for recurrent stroke or TIA after percutaneous PFO closure compared with medically treated patients (7.3% vs. 33.2%; p = 0.01; 95% CI 0.08 to 0.81, and 6.5% vs. 22.2%; p = 0.04; 95% CI 0.14 to 0.99, respectively).

CONCLUSIONS: Percutaneous PFO closure appears at least as effective as medical treatment for prevention of recurrent cerebrovascular events in cryptogenic stroke patients with PFO. It might be more effective than medical treatment in patients with complete closure and more than one cerebrovascular event.

Abbreviations and Acronyms
  CI = confidence interval
  PFO = patent foramen ovale
  PICSS = Patent foramen ovale In Cryptogenic Stroke Study
  RR = risk ratio
  TIA = transient ischemic attack




This article has been cited by other articles:


Home page
 J Am Coll Cardiol IntvHome page
D. Hildick-Smith, M. Behan, P. Haworth, B. Rana, and M. Thomas
Patent Foramen Ovale Closure Without Echocardiographic Control: Use of "Standby" Intracardiac Ultrasound
J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 387 - 391.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
A Wahl, M Kunz, A Moschovitis, T Nageh, M Schwerzmann, C Seiler, H P Mattle, S Windecker, and B Meier
Long-term results after fluoroscopy-guided closure of patent foramen ovale for secondary prevention of paradoxical embolism
Heart, March 1, 2008; 94(3): 336 - 341.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
D Kenny, M Turner, and R Martin
When to close a patent foramen ovale
Arch. Dis. Child., March 1, 2008; 93(3): 255 - 259.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. J. Sommer, Z. M. Hijazi, and J. F. Rhodes Jr
Pathophysiology of Congenital Heart Disease in the Adult: Part I: Shunt Lesions
Circulation, February 26, 2008; 117(8): 1090 - 1099.
[Full Text] [PDF]

Home page
 Contin Educ Anaesth Crit Care PainHome page
P. A. Calvert and A. A. Klein
Anaesthesia for percutaneous closure of atrial septal defects
CEACCP, February 1, 2008; 8(1): 16 - 20.
[Full Text] [PDF]

Home page
 NEJMHome page
M. Handke, A. Harloff, M. Olschewski, A. Hetzel, and A. Geibel
Patent Foramen Ovale and Cryptogenic Stroke in Older Patients
N. Engl. J. Med., November 29, 2007; 357(22): 2262 - 2268.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
T. L. P. Slottow, D. H. Steinberg, and R. Waksman
Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel Meeting on Patent Foramen Ovale Closure Devices
Circulation, August 7, 2007; 116(6): 677 - 682.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
N. Botto, I. Spadoni, S. Giusti, L. Ait-Ali, R. Sicari, and M. G. Andreassi
Prothrombotic Mutations as Risk Factors for Cryptogenic Ischemic Cerebrovascular Events in Young Subjects With Patent Foramen Ovale
Stroke, July 1, 2007; 38(7): 2070 - 2073.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
H Madani and P A Ransom
Paradoxical embolus illustrating speed of action of recombinant tissue plasminogen activator in massive pulmonary embolism
Emerg. Med. J., June 1, 2007; 24(6): 441 - 441.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EchocardiogrHome page
O. I.I. Soliman, M. L. Geleijnse, F. J. Meijboom, A. Nemes, O. Kamp, P. Nihoyannopoulos, N. Masani, S. B. Feinstein, and F. J. Ten Cate
The use of contrast echocardiography for the detection of cardiac shunts
Eur J Echocardiogr, June 1, 2007; 8(3): s2 - s12.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
S. Ghosh, A. K. Ghosh, and S. K. Ghosh
Patent foramen ovale and atrial septal aneurysm in cryptogenic stroke
Postgrad. Med. J., March 1, 2007; 83(977): 173 - 177.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
D J H McCabe and R D Rakhit
Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke
J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 14 - 24.
[Abstract] [Full Text] [PDF]

Home page
 StrokeHome page
E. Bedard, J. Rodes-Cabau, C. Houde, A. Mackey, D. Rivest, S. Cloutier, M. Noel, A. Marrero, J.-M. Cote, P. Chetaille, et al.
Enhanced Thrombogenesis but Not Platelet Activation Is Associated With Transcatheter Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke
Stroke, January 1, 2007; 38(1): 100 - 104.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Cecconi, A. Quarti, F. Bianchini, S. Bucari, C. Costantini, A. Giovagnoni, and G. P. Perna
Late Cardiac Perforation After Transcatheter Closure of Patent Foramen Ovale
Ann. Thorac. Surg., June 1, 2006; 81(6): e29 - e30.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G Agnoletti, Y Boudjemline, P Ou, D Bonnet, and D Sidi
Right to left shunt through interatrial septal defects in patients with congenital heart disease: results of interventional closure
Heart, June 1, 2006; 92(6): 827 - 831.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
C. Spies, R. Strasheim, I. Timmermanns, and R. Schraeder
Patent foramen ovale closure in patients with cryptogenic thrombo-embolic events using the Cardia PFO occluder
Eur. Heart J., February 1, 2006; 27(3): 365 - 371.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
J. D.R. Thomson
Percutaneous PFO closure, further data but many unanswered questions
Eur. Heart J., February 1, 2006; 27(3): 258 - 259.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
B. Meier
Patent Foramen Ovale, Guilty But Only as a Gang Member and for a Lesser Crime
J. Am. Coll. Cardiol., January 17, 2006; 47(2): 446 - 448.
[Full Text] [PDF]

Home page
 NEJMHome page
D. D. Hegland, G. A. Kunz, J. K. Harrison, and A. Wang
Clinical problem-solving. A hole in the argument.
N. Engl. J. Med., December 1, 2005; 353(22): 2385 - 2390.
[Full Text] [PDF]

Home page
 CirculationHome page
S. Homma and R. L. Sacco
Patent Foramen Ovale and Stroke
Circulation, August 16, 2005; 112(7): 1063 - 1072.
[Full Text] [PDF]

Home page
 JAMAHome page
W. H. Maisel and W. K. Laskey
Patent Foramen Ovale Closure Devices: Moving Beyond Equipoise
JAMA, July 20, 2005; 294(3): 366 - 369.
[Full Text] [PDF]

Home page
 NeurologyHome page
S. R. Messe, B. Cucchiara, J. Luciano, and S. E. Kasner
PFO management: Neurologists vs cardiologists
Neurology, July 12, 2005; 65(1): 172 - 173.
[Full Text] [PDF]

Home page
 HeartHome page
B Meier
Closure of patent foramen ovale: technique, pitfalls, complications, and follow up
Heart, April 1, 2005; 91(4): 444 - 448.
[Full Text] [PDF]

Home page
 HeartHome page
F A Flachskampf and W G Daniel
Closure of patent foramen ovale: is the case really closed as well?
Heart, April 1, 2005; 91(4): 449 - 450.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al.
Highlights of the year in JACC 2004
J. Am. Coll. Cardiol., January 4, 2005; 45(1): 137 - 153.
[Full Text] [PDF]

Home page
 Journal Watch CardiologyHome page
Devices for PFO Closure?
Journal Watch Cardiology, October 22, 2004; 2004(1022): 4 - 4.
[Full Text]


HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2004 by the American College of Cardiology Foundation.