Closure of patent foramen ovale after cryptogenic stroke.

摘要

About 80% of strokes are ischaemic. Their cause remains cryptogenic in 35-40%. The frequency of patent foramen ovale is higher in patients with cryptogenic stroke than in the general population. The combined evidence of patent foramen ovale with an atrial septal aneurysm seems to be associated with a stronger risk for recurrent neurological events.Paradoxical embolism of thrombus or small clots from the peripheral venous system during right-to-left shunt is suspected to be the main cause of cryptogenic stroke associated with patent foramen ovale. At present, patients with cryptogenic stroke and patent foramen ovale receive different treatments depending on their physician, including antiplatelet treatment, anticoagulation, or transcatheter closure of patent foramen ovale.We could find only one randomised trial that included anticoagulation and antiplatelet treatment with a subgroup analysis of patients after cryptogenic stroke.The 2-year rate of recurrent stroke or death was lower in patients receivingwarfarin than in patients with antiplatelet therapy (8-8% vs 16-9%, odds ratio 0-47, 95% Cl 0-22-1-04). Patients without patent foramen ovale had a 2-year event rate of 12-7% vs 14-3% in those with patent foramen ovale (0-86, 0-41-1-80). Data for atrial septal aneurysm in combination with patent foramen ovale per treatment group in patients with cryptogenic stroke were not given. This result would be interesting because, in a study with consecutive enrolment of patients, the risk for recurrent stroke or transient ischaemic attack was amplified in patients with patent foramen ovale and atrial septal aneurysm during antiplatelet treatment.Patients with patent foramen ovale without atrial septal aneurysm did as well as patients without patent foramen ovale in the absence of atrial septal aneurysm (0-86, 0-31-2-36).