Document Detail


Management of patent foramen ovale and stroke.
MedLine Citation:
PMID:  20848324     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Paradoxical embolization is a rare but well-recognized cause of stroke. Some studies have suggested a link between patent foramen ovale (PFO) and a higher risk of ischemic stroke through this mechanism. PFO is more commonly seen in patients with cryptogenic stroke, but a clear causative relationship between the two is not well established. Other anatomic features associated with a PFO could increase the risk of a recurrent stroke, including an atrial septal aneurysm (ASA), a large PFO, and spontaneous right-to-left shunt at rest. An underlying hypercoagulable state should be ruled out if a PFO is found in a patient with a stroke or transient ischemic attack who has no other identifiable source. Options for secondary prevention in these patients include antiplatelet therapy, anticoagulation, and surgical or endovascular closure. Studies have not shown any advantage of warfarin over aspirin. Surgical closure is a less favorable option because of its high perioperative risks. To date, retrospective studies show variable results of endovascular closure for prevention of stroke. Several randomized prospective studies currently under way are expected to conclusively answer this question. Until these data is available, antiplatelet therapy remains the first-line treatment and endovascular closure should be considered in selected cases.
Authors:
Mouhammad A Jumaa; Lawrence R Wechsler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in neurology     Volume:  12     ISSN:  1534-3138     ISO Abbreviation:  Curr Treat Options Neurol     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-10     Completed Date:  2011-11-10     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  9815940     Medline TA:  Curr Treat Options Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  483-91     Citation Subset:  -    
Affiliation:
Department of Neurology, UPMC Stroke Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, C400, Pittsburgh, PA, 15213, USA, jumaam@upmc.edu.
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