Re-evaluation of PFO Closure in Cryptogenic Stroke?
Re-evaluation of PFO Closure in Cryptogenic Stroke?
If we look at the results of these 3 trials, none was significant for the primary endpoint. But if we put all the trials together, we would have had 39 events in the intervention group and 56 events in the medical group, which would just reach statistical significance.
What is the clinical consequence? We still do not know whether PFO closure really prevents stroke in patients with cryptogenic stroke. My personal advice would be that very careful selection of patients could tease out the ones who would benefit from PFO closure. In particular, these would be the patients who have a large PFO with atrial septal aneurysm and patients for whom it is highly indicative that the PFO has played a role -- for example, if a stroke occurs during a Valsalva maneuver.
I would certainly consider PFO closure in patients with PFO who have a recurrent stroke and for whom medical therapy is obviously failing.
We now have 3 trials on PFO closure, all of which were negative. Does this mean that we should give up PFO closure? I do not know. We have to await the results of proper meta-analyses and see what the guidelines will say.
Ladies and gentlemen, I am Christoph Diener, a stroke neurologist from the University of Essen in Germany. Thank you for listening.
Combining the Results Changes Significance Slightly
If we look at the results of these 3 trials, none was significant for the primary endpoint. But if we put all the trials together, we would have had 39 events in the intervention group and 56 events in the medical group, which would just reach statistical significance.
What is the clinical consequence? We still do not know whether PFO closure really prevents stroke in patients with cryptogenic stroke. My personal advice would be that very careful selection of patients could tease out the ones who would benefit from PFO closure. In particular, these would be the patients who have a large PFO with atrial septal aneurysm and patients for whom it is highly indicative that the PFO has played a role -- for example, if a stroke occurs during a Valsalva maneuver.
I would certainly consider PFO closure in patients with PFO who have a recurrent stroke and for whom medical therapy is obviously failing.
We now have 3 trials on PFO closure, all of which were negative. Does this mean that we should give up PFO closure? I do not know. We have to await the results of proper meta-analyses and see what the guidelines will say.
Ladies and gentlemen, I am Christoph Diener, a stroke neurologist from the University of Essen in Germany. Thank you for listening.
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