Amplatzer PFO Occluder Device may Prevent Recurrent Stroke in Patients with Patent Foramen Ovale and Cryptogenic Stroke: A Meta-Analysis of Randomised Trials

• Published in: Heart, lung & circulation lung & circulation, 2014-04, Vol.23 (4), p.303-308
• Main Authors: Pandit, Anil, MD, Aryal, Madan Raj, MD, Pandit, Aashrayata Aryal, MD, Jalota, Leena, MD, Kantharajpur, Sudheer, MD, Hakim, Fayaz A., MD, Lee, Howard R., MD
• Format: Article
• Language: English
• Subjects: and meta-analysis; Cardiovascular; Cryptogenic stroke; device closure; Foramen Ovale - surgery; Humans; PubMed; Randomized Controlled Trials as Topic; Septal Occluder Device; Stroke - etiology; Stroke - prevention & control
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2013.12.003

Objective To review efficacy of percutaneous closure of patent foramen ovale compared with medical therapy in prevention of recurrent strokes in patients with cryptogenic stroke. Methods and Results Electronic databases; PUBMED, EMBASE, Cochrane registry and web of knowledge were searched for relevant studies. In three randomised clinical trials involving 2303 participants, risk of the recurrent strokes (pooled HR 0.62, 95% CI = 0.36-1.07, P = 0.09, I2 =10%) did not show benefit with device closure when compared with medical therapy group on meta-analysis of all three trials. However, on sensitivity analysis in trials using Amplatzer PFO occluder device, the closure of PFO was associated with significantly lower recurrent strokes (pooled HR = 0.44, 95% CI = 0.21-0.94, P = 0.03, I2 = 0%) compared with medical therapy. Conclusion The closure of PFO with Amplatzer PFO occluder device was associated with significant reduction in recurrent strokes in patients with cryptogenic stroke and patent foramen ovale. The better outcome in prevention of secondary stroke in patients with cryptogenic stroke and PFO may be associated with type of closure device used.