Percutaneous patent foramen ovale closure in prevention of recurrence of cryptogenic stroke: A meta-analysis

  AIM   AIM A meta-analysis was performed using randomized controlled trials on efficacy of transcatheter PFO closure in patients with cryptogenic stroke.

  METHODS   Web of Science, EMBASE, PubMed, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) with medical therapy as control. The primary outcome was recurrent stroke and transient-ischemic attack (TIA). Original data, hazard ratio (HR) with 95% confidence interval (95%CI) were abstracted to calculate a pooled effect size.

  RESULTS   The meta-analysis showed benefit with device closure when compared with medical therapy with an HR of 0.47(95%CI:0.27-0.84, P<0.01) in the intention-to-treat cohort. There was no significant difference with respect to the all-cause mortality between the device closure and the drug treatment during the follow-up (OR=0.83, 95%CI: 0.37-1.85, I²=21.8%, P=0.655). There was a significantly higher incidence of new-onset atrial fibrillation in PFO closure patients (OR=5.44,95%CI: 2.92-10.15, I²=35.3%, P<0.01). Patients with a substantial PFO shunt benefit the greatest with device closure with a pooled OR of 0.31 (95%CI: 0.14-0.69, I²=0, P<0.01). PFO Patients with an atrial septal aneurysm benefit from device closure (OR=0.44, 95%CI: 0.23-0.81, I²=63.3%, P<0.01).

  CONCLUSION   The meta-analysis concluded that PFO closure was associated with significantly lower risk of recurrent stroke in PFO patients with cryptogenic stroke than with medical therapy alone. The benefit of PFO closure was greater in patients with a substantial shunt and atrial septal aneurysm. PFO closure was associated with higher rates of new-onset atrial fibrillation.