In:
Journal of Stroke, Korean Stroke Society, Vol. 25, No. 3 ( 2023-09-30), p. 338-349
Abstract:
Patent foramen ovale (PFO) closure, along with medical therapy, has emerged as the therapeutic gold standard in younger ( 〈 60-year-old) patients with a PFO-related stroke for preventing recurrent events. However, PFO management guidelines lack definite recommendations for older ( 〉 60 years) patients with a PFO-related cerebrovascular event, a complex group of patients who were mostly excluded from PFO closure clinical trials. Nevertheless, several studies have shown a higher prevalence of PFO among older patients with cryptogenic stroke, and its presence has been associated with an increased risk of recurrent events. Furthermore, older patients exhibit a higher prevalence of high-risk PFO anatomical features, present inherent age-related risk factors that might increase the risk of paradoxical embolism through a PFO, and have a higher incidence of ischemic events after a PFO-related event. Additionally, observational studies have shown the safety and preliminary efficacy of PFO closure in older PFO-related stroke patients. Yet, higher rates of recurrent cerebrovascular events and new-onset atrial fibrillation were observed in some studies among older patients compared to their younger counterparts. After careful case-by-case evaluation, including the assessment of hidden potential cardioembolic sources of a cryptogenic stroke other than PFO, transcatheter PFO closure might be a safe and effective therapeutic option for preventing recurrent thromboembolic events in patients 〉 60 years with a high-risk PFO-associated stroke. Ongoing trials will provide important insights into the role of PFO closure in the elderly population.
Type of Medium:
Online Resource
ISSN:
2287-6391
,
2287-6405
DOI:
10.5853/jos.2023.01599
Language:
English
Publisher:
Korean Stroke Society
Publication Date:
2023
detail.hit.zdb_id:
2814366-8
