Reprint of : Transcatheter closure of patent foramen ovale to prevent stroke recurrence in patients with otherwise unexplained ischaemic stroke: Expert consensus of the French Neurovascular Society and the French Society of Cardiology - 18/02/20
Fermeture percutanée du foramen ovale perméable chez les patients ayant infarctus cérébral par ailleurs inexpliqué. Consensus d’experts de la Société Française Neuro-Vasculaire et de la Société Française de Cardiologie
, Laurent Derex b, Patrice Guérin c, Benoit Guillon d, Gilbert Habib e, Jean-Michel Juliard f, Eloi Marijon g, Evelyne Massardier h, Nicolas Meneveau i, Fabrice Vuillier jBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 9 |
| Iconographies | 2 |
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Summary |
Background |
Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke.
Aim |
To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke.
Methods |
Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses.
Results |
The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16–60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years.
Conclusions |
Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.
Le texte complet de cet article est disponible en PDF.Keywords : Ischaemic stroke, Patent foramen ovale, Atrial septal aneurysm ;Prevention, Randomized clinical trial
Abbreviations : AF, ASA, CI, HR, PFO, RCT, RR
Plan
| ☆ | This Expert Consensus has been originally published in the Archives of Cardiovascular Disease. We thank the editors, the publisher and the authors to have given permission for this reprint (original text without French résumé). Do not cite the present publication in Revue neurologique but the original publication as in: Arch Cardiovasc Dis 2019;112:532–42. j.acvd.2019.06.002. |
Vol 176 - N° 1-2
P. 53-61 - janvier 2020 Retour au numéro
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