BEGIN YOUR JOURNEY TOWARDS PREVENTING CRYPTOGENIC STROKE
If you’ve had a stroke due to an unknown cause, learn how you may be able to prevent another with the Amplatzer™ PFO Occluder.
The United States and countries across the globe have updated their stroke guidelines to include PFO closure. See below for brief summaries of the guidelines, as well as links to the full publications.
An updated practice advisory from the American Academy of Neurology (AAN) concludes that patent foramen ovale (PFO) closure may be recommended for some patients with a PFO, an embolic-appearing infarct and no other mechanism of stroke identified. This advisory has been endorsed by the American Heart Association/American Stroke Association, the Society for Cardiovascular Angiography and Interventions and the European Academy of Neurology.
Recommendation: In patients younger than 60 years with a PFO and an embolic-appearing infarct and no other mechanism of stroke identified, clinicians may recommend closure following a discussion of potential benefits (reduction of stroke recurrence) and risks (procedural complication and atrial fibrillation) (Level C).
Published by the Stroke Foundation, the Australian guidelines were written by Content Development Working Group, a multi-disciplinary group of physicians involved in stroke care. In summary, the guidelines involving PFO closure state:
In ischaemic stroke patients aged <60 in whom a patent foramen ovale is considered the likely cause of stroke after thorough exclusion of other aetiologies, percutaneous closure of the PFO is recommended (Turc et al. 2018 , Saver et al. 2018 ).
Physicians from cardiology, internal medicine and neurology joined together to publish new stroke guidelines related to PFO closure in patients with cryptogenic stroke. The guidelines state that interventional PFO closure should be performed in patients aged 16 to 60 years (after extensive neurological and cardiological diagnostic work-up) with a history of cryptogenic ischaemic stroke and patent foramen ovale, with moderate or extensive right-to-left shunt. Recommendation level A, Evidence level I.
Among patients younger than age 60 who have had a cryptogenic ischemic stroke thought to be secondary to PFO (due to absence of other etiologies):
Published in the International Journal of Stroke, the Canadian guidelines were written by a group of physicians on behalf of the Heart and Stroke Foundation Canadian Stroke Best Practice Committees. In summary, PFO guidelines have been updated with the following:
For carefully-selected patients with a recent ischemic stroke or TIA attributed to a PFO, PFO device closure plus long-term antiplatelet therapy is recommended over long-term antithrombotic therapy alone provided all the following criteria are met:
[Evidence Level A]:
In addition to guidelines, there have also been position papers and consensus statements published regarding PFO closure in patients with cryptogenic stroke.
The Japan Stroke Society, The Japanese Circulation Society, and Japanese Association of Cardiovascular Intervention and Therapeutics came together to review the evidence on PFO closure and recommend the following when it comes to selecting the appropriate patient for PFO closure:
Indication criteria for percutaneous closure of PFO for the purpose of stroke recurrence prevention:
EuroIntervention published a European position paper regarding the management of patients with PFO. The paper was developed by eight scientific societies and international stroke experts.
“Position of our societies is to perform percutaneous closure of PFO in carefully selected patients from 18 to 65 years with confirmed cryptogenic stroke, TIA or systemic embolism and estimated high probability of causal role of PFO as assessed by clinical, anatomic and imaging features.”
“The interventional procedure must be proposed to each patient evaluating the individual probability of benefit based on an assessment of both the role of the PFO in the thromboembolic event and the expected results and risks of a lifelong medical therapy.”