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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Who benefits from percutaneous closure of patent foramen ovale vs medical therapy for stroke prevention? In-depth and updated meta-analysis of randomized trials
Khagendra Dahal, Adil Yousuf, Hussam Watti, Brannen Liang, Sharan Sharma, Jharendra Rijal, Pavan Katikaneni, Kalgi Modi, Neeraj Tandon, Michael Azrin, Juyong Lee
Khagendra Dahal, Adil Yousuf, Hussam Watti, Pavan Katikaneni, Kalgi Modi, Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
Brannen Liang, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
Sharan Sharma, Kansas City Heart Rhythm Institute, Overland Park, KS 66215, United States
Jharendra Rijal, Division of Cardiology, Hartford Medical Center, Hartford, CT 06102, United States
Neeraj Tandon, Cardiology Section, Overton Brooks VA Medical Center, Shreveport, LA 71101, United States
Michael Azrin, Juyong Lee, Division of Cardiology, University of Connecticut Health Center, Farmington, CT 06030, United States
Author contributions: Dahal K, Watti H and Lee J contributed to study concept and design; Dahal K, Yousuf A, Watti H, Liang B, Sharma, Rijal J, Katikaneni P, Modi K, Tandon N, Azrin M and Lee J contributed to acquisition, analysis, or interpretation of data; Dahal K, Yousuf A, Watti H and Liang B contributed to drafting of the manuscript; Dahal K, Yousuf A, Watti H, Liang B, Sharma S, Rijal J, Katikaneni P, Modi K, Tandon N, Azrin M and Lee J contributed to critical revision of the manuscript for important intellectual content; Dahal K contributed to statistical analysis; Modi K, Tandon N, Azrin M and Lee J contributed to study supervision.
Conflict-of-interest statement: None declared.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Juyong Lee, MD, PhD, Division of Cardiology, University of Connecticut Health Center, Farmington, CT 06030, United States. jlee@uchc.edu
Telephone: +1-860-6793343
Received: January 8, 2019
Peer-review started: January 8, 2019
First decision: January 21, 2019
Revised: February 11, 2019
Accepted: March 27, 2019
Article in press: March 28, 2019
Published online: April 26, 2019
ARTICLE HIGHLIGHTS
Research background
A few randomized clinical trials (RCT) and their meta-analyses have found patent foramen ovale closure (PFOC) to be beneficial in prevention of stroke compared to medical therapy.
Research motivation
Whether the benefit is extended across all groups of patients remains unclear.
Research objectives
To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs.
Research methods
Following standard technique, a meta-analysis of randomized clinical trials was performed. Random-effects model was used to analyze summary results.
Research results
PFO closure is beneficial in preventing stroke in patients with stroke and a PFO. In certain population, the benefits are clear.
Research conclusions
This study showed that PFO closure is beneficial in patients with PFO and stroke. It was beneficial in patients who were male, younger than 45, had atrial septal aneurysm and had a large shunt.
Research perspectives
Future research should compare anticoagulation vs PFO closure and establish whether PFO closure can be useful in all group of patients.
