Stroke Alert
Patent Foramen Ovale Does Not Confer a Higher Risk of Recurrent Events in Cryptogenic Stroke
By Matthew E. Fink, MD
Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink is a retained consultant for Procter & Gamble.
This article originally appeared in the December 2014 issue of Neurology Alert. It was peer reviewed by M. Flint Beal, MD, Anne Parrish Titzel Professor, Department of Neurology and Neuroscience, Weill Cornell Medical Center. Dr. Beal reports no financial relationships relevant to this field of study. Matthew E. Fink, MD, is editor in chief of Neurology Alert.
Katsanos A, et.al. Recurrent stroke and patent foramen ovale: A systematic review and meta-analysis. Stroke 2014;45:3352-3359.
Patent foramen ovale (PFO) is common in both the general population, as well as in patients with cryptogenic stroke, with an estimated prevalence somewhere between 15-35%. Recurrent neurovascular events, both recurrent ischemic stroke as well as transient ischemic attacks, are frequent in these patients, but it is not clear whether patients with PFOs have an increased rate of recurrent events compared to those patients who do not have PFOs. Katsanos and colleagues performed a review and meta-analysis of all available prospective studies that reported recurrent cerebrovascular events in patients who were diagnosed with cryptogenic stroke or transient ischemic attacks, and were treated medically. These were then compared to the control ischemic stroke patients who did not have PFOs. Fourteen eligible studies were identified with a total of 4251 patients. Patients with stroke and PFO did not have a higher risk of recurrent stroke/transient ischemic attacks (risk ratio, 1.18; 95% confidence interval, 0.78-1.79; P = 0.03). The authors also compared the size of the PFO with the risk of recurrent events and did not find any association.
Based on the available evidence, there does not appear to be an increased risk of recurrent cerebral ischemic events in patients with PFO compared to those without a PFO.
