Surgical vs Medical Therapy Alone: Which Better Prevents Recurrent Stroke?
Transcatheter device closure is associated with a lower risk for recurrent stroke than medical therapy alone in patients with patent foramen ovale (PFO) and cryptogenic stroke, according to a recent systematic review and meta-analysis.
For their review, the researchers assessed data on 4 high-quality trials that had studied adult patients with PFO and cryptogenic stroke (n =2892). Data were obtained from PubMed and the Cochrane Library from inception to October 2017, as well as from reference lists and abstracts from cardiology meetings.
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All studies included in the analysis had compared stroke outcomes and potential harms in those who received transcatheter device closure vs those who received medical therapy alone. Study data was independently extracted by 2 investigators.
Findings revealed that PFO closure was associated with a 3.2% lower absolute risk for recurrent stroke (risk difference −0.032) compared with medical therapy alone. However, the researchers found that closure of PFOs was associated with higher rates of new-onset atrial fibrillation (AF) compared with medical therapy alone in all trials. They noted that this outcome had notable heterogeneity between trials (I2 = 82.5%), and high rates of events in some groups led to extreme confidence interval values.
No difference in the rates of transient ischemic attack or major bleeding was observed between treatment strategies.
“In patients with PFO and cryptogenic stroke, transcatheter device closure decreases risk for recurrent stroke compared with medical therapy alone,” the researchers concluded. “Because recurrent stroke rates are low even with medical therapy alone and PFO closure might affect AF risk, shared decision making is crucial for this treatment.”
—Christina Vogt
Reference:
Shah R, Nayyar M, Jovin IS, et al. Device closure versus medical therapy alone for patent foramen ovale in patients With cryptogenic stroke: a systematic review and meta-analysis [Published online January 9, 2018]. Ann Intern Med. doi:10.7326/M17-2679.