Conflict of interest: Bernhard Meier and Heinrich P. Mattle are the principal investigators of the PC Trial, which is supported by a grant from AGA Medical. Heinrich Mattle has received research grants, speaker's fees, and consulting honoraria from AGA Medical, and Bernhard Meier from AGA Medical, Johnson & Johnson, Occlutech, St. Jude Medical, and NMT Technologies. Krassen Nedeltchev is the principal investigator of the Swiss PFO Consortium (http://www.pfoconsortium.org), which is supported by a grant from the Swiss National Research Foundation.
Prevention of stroke in patients with patent foramen ovale
Article first published online: 7 MAR 2010
© 2010 The Authors. Journal compilation © 2010 World Stroke Organization
International Journal of Stroke
Volume 5, Issue 2, pages 92–102, April 2010
How to Cite
Mattle, H. P., Meier, B. and Nedeltchev, K. (2010), Prevention of stroke in patients with patent foramen ovale. International Journal of Stroke, 5: 92–102. doi: 10.1111/j.1747-4949.2010.00413.x
- Issue published online: 7 MAR 2010
- Article first published online: 7 MAR 2010
- device closure;
- patent foramen ovale;
Patent foramen ovale is found in 24% of healthy adults and 38% of patients with cryptogenic stroke. This ratio and case reports indicate that patent foramen ovale and stroke are associated, probably because of paradoxical embolism. In healthy people with patent foramen ovale, embolic events are not more frequent than in controls, and therefore no primary prevention is needed. However, once ischaemic events occur, the risk of recurrence is substantial and prevention becomes an issue. Acetylsalicylic acid and warfarin reduce this risk to the same level as in patients without patent foramen ovale. Patent foramen ovale with a coinciding atrial septal aneurysm, spontaneous or large right-to-left shunt, or multiple ischaemic events potentiates the risk of recurrence. Transcatheter device closure has therefore become an intriguing addition to medical treatment, but its therapeutic value still needs to be confirmed by randomised-controlled trials.