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Muengtaweepongsa S, Tantibundhit C. Microembolic signal detection by transcranial Doppler: Old method with a new indication. World J Methodol 2018; 8:40-43. [PMID: 30519538 PMCID: PMC6275557 DOI: 10.5662/wjm.v8.i3.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/30/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
Transcranial Doppler (TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke (or stroke with undetermined etiology), and patent foramen ovale (PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.
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Affiliation(s)
- Sombat Muengtaweepongsa
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Charturong Tantibundhit
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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Ahmad Y, Howard JP, Arnold A, Shin MS, Cook C, Petraco R, Demir O, Williams L, Iglesias JF, Sutaria N, Malik I, Davies J, Mayet J, Francis D, Sen S. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials. Eur Heart J 2018; 39:1638-1649. [PMID: 29590333 PMCID: PMC5946888 DOI: 10.1093/eurheartj/ehy121] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/09/2017] [Accepted: 02/26/2018] [Indexed: 01/10/2023] Open
Abstract
Aims The efficacy of patent foramen ovale (PFO) closure for cryptogenic stroke has been controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) comparing device closure with medical therapy to prevent recurrent stroke for patients with PFO. Methods and results We systematically identified all RCTs comparing device closure to medical therapy for cryptogenic stroke in patients with PFO. The primary efficacy endpoint was recurrent stroke, analysed on an intention-to-treat basis. The primary safety endpoint was new onset atrial fibrillation (AF). Five studies (3440 patients) were included. In all, 1829 patients were randomized to device closure and 1611 to medical therapy. Across all patients, PFO closure was superior to medical therapy for prevention of stroke [hazard ratio (HR) 0.32, 95% confidence interval (95% CI) 0.13-0.82; P = 0.018, I2 = 73.4%]. The risk of AF was significantly increased with device closure [risk ratio (RR) 4.68, 95% CI 2.19-10.00, P<0.001, heterogeneity I2 = 27.5%)]. In patients with large shunts, PFO closure was associated with a significant reduction in stroke (HR 0.33, 95% CI 0.16-0.72; P = 0.005), whilst there was no significant reduction in stroke in patients with a small shunt (HR 0.90, 95% CI 0.50-1.60; P = 0.712). There was no effect from the presence or absence of an atrial septal aneurysm on outcomes (P = 0.994). Conclusion In selected patients with cryptogenic stroke, PFO closure is superior to medical therapy for the prevention of further stroke: this is particularly true for patients with moderate-to-large shunts. Guidelines should be updated to reflect this.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - James P Howard
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Ahran Arnold
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Matthew Shun Shin
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Christopher Cook
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Ricardo Petraco
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Ozan Demir
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Luke Williams
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Juan F Iglesias
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Nilesh Sutaria
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Iqbal Malik
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Justin Davies
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Jamil Mayet
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Darrel Francis
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Sayan Sen
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
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Hakeem A, Cilingiroglu M, Katramados A, Boudoulas KD, Iliescu C, Gundogdu B, Marmagkiolis K. Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data. Catheter Cardiovasc Interv 2018; 92:1153-1160. [DOI: 10.1002/ccd.27487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/30/2017] [Accepted: 12/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Abdul Hakeem
- Robert Wood Johnson Hospital, Rutgers University; New Brunswick New Jersey
| | - Mehmet Cilingiroglu
- School of Medicine; Arkansas Heart Hospital, Little Rock, AR and Koc University; Istanbul Turkey
| | - Angelos Katramados
- Department of Neurology; Henry Ford Health Sciences Center; Detroit Michigan
| | | | | | - Betul Gundogdu
- Department of Neurology; University of Arkansas for Medical Sciences; Little Rock Arkansas
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Werlang ME, Palmer WC, Boyd EA, Cangemi DJ, Harnois DM, Taner CB, Stancampiano FF. Patent foramen ovale in liver transplant recipients does not negatively impact short-term outcomes. Clin Transplant 2015; 30:26-32. [PMID: 26448343 DOI: 10.1111/ctr.12643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/28/2022]
Abstract
AIM Patent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of a PFO in patients undergoing liver transplantation (LT) is unknown. OBJECTIVE Assess the impact of PFO and physiologic intrapulmonary shunt (IPS) on the perioperative outcomes of patients who underwent LT. METHODS We performed a retrospective, intention-to-treat analysis of patients with PFO and controls without PFO who underwent LT at Mayo Clinic in Florida between 2008 and 2013. Patients with physiologic IPS were also analyzed. The cohorts were compared for baseline characteristics, length of stay in the intensive care unit (ICU), postoperative oxygen requirements, 30-d cerebrovascular accidents, and mortality. RESULTS Of the 935 patients who underwent LT, 10.4% had proven PFO by pre-LT echocardiogram. Control patients (n = 101) were statistically older than PFO and IPS (n = 56) patients, but similar in sex, BMI, Model for End-stage Liver Disease score, American Society of Anesthesiologist score, and left ventricular ejection fraction. PFO and IPS patients had similar length of stay in the ICU, mechanical ventilation times, post-LT oxygen requirements, and 30-d mortality compared to controls. Subgroup analysis showed similar outcomes for large PFO and IPS patients to controls. CONCLUSIONS The presence of PFO did not have a negative impact on perioperative LT outcomes.
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Affiliation(s)
- Monia E Werlang
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - David J Cangemi
- Department of Digestive and Liver Diseases, Gastroenterology, University of Texas Southwestern, Dallas, TX, USA
| | - Denise M Harnois
- Division of Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Cemal B Taner
- Division of Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
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Agarwal S, Tuzcu EM, Kapadia SR. Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective. J Am Heart Assoc 2015; 4:e002353. [PMID: 26486167 PMCID: PMC4845140 DOI: 10.1161/jaha.115.002353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Shikhar Agarwal
- Section of Interventional CardiologyHeart and Vascular Institute, Cleveland ClinicClevelandOH
| | - E. Murat Tuzcu
- Section of Interventional CardiologyHeart and Vascular Institute, Cleveland ClinicClevelandOH
| | - Samir R. Kapadia
- Section of Interventional CardiologyHeart and Vascular Institute, Cleveland ClinicClevelandOH
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Li J, Liu J, Liu M, Zhang S, Hao Z, Zhang J, Zhang C. Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack. Cochrane Database Syst Rev 2015; 2015:CD009938. [PMID: 26346232 PMCID: PMC7389291 DOI: 10.1002/14651858.cd009938.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The optimal therapy for preventing recurrent stroke in people with cryptogenic stroke and patent foramen ovale (PFO) has not been defined. The choice between medical therapy (antithrombotic treatment with antiplatelet agents or anticoagulants) and transcatheter device closure has been the subject of intense debate over the past several years. Despite the lack of scientific evidence, a substantial number of people undergo transcatheter device closure (TDC) for secondary stroke prevention. OBJECTIVES To: 1) compare the safety and efficacy of TDC with best medical therapy alone for preventing recurrent stroke (fatal or non-fatal) or transient ischemic attacks (TIAs) in people with PFO and a history of cryptogenic stroke or TIA; 2) identify specific subgroups of people most likely to benefit from closure for secondary prevention; and 3) assess the cost-effectiveness of this strategy, if possible. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (July 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2014), MEDLINE (1950 to July 2014) and EMBASE (1980 to July 2014). In an effort to identify unpublished and ongoing trials we searched seven trials registers and checked reference lists. SELECTION CRITERIA We included randomized controlled trials (RCTs), irrespective of blinding, publication status, and language, comparing the safety and efficacy of device closure with medical therapy for preventing recurrent stroke or TIA in people with PFO and a history of cryptogenic stroke or TIA. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed quality and risk of bias, and extracted data. The primary outcome measures of this analysis were the composite endpoint of ischemic stroke or TIA events as well as recurrent fatal or non-fatal ischemic stroke. Secondary endpoints included all-cause mortality, serious adverse events (atrial fibrillation, myocardial infarction, bleeding) and procedural success and effective closure. We used the Mantel-Haenszel method to obtain pooled risk ratios (RRs) using the random-effects model regardless of the level of heterogeneity. We pooled data for the primary outcome measure with the generic inverse variance method using the random-effects model, yielding risk estimates as pooled hazard ratio (HR), which accounts for time-to-event outcomes. MAIN RESULTS We included three RCTs involving a total of 2303 participants: 1150 participants were randomized to receive TDC and 1153 participants were randomized to receive medical therapy. Overall, the risk of bias was regarded as high. The mean follow-up period of all three included trials was less than five years. Baseline characteristics (age, sex, and vascular risk factors) were similar across trials. Intention-to-treat analyses did not show a statistically significant risk reduction in the composite endpoint of recurrent stroke or TIA in the TDC group when compared with medical therapy (RR 0.73, 95% CI 0.45 to 1.17). A time-to-event analysis combining the results of two RCTs also failed to show a significant risk reduction with TDC (HR 0.69, 95% CI 0.43 to 1.13). When assessing stroke prevention alone, TDC still did not show a statistically significant benefit (RR 0.61, 95% CI 0.29 to 1.27) (HR 0.55, 95% CI 0.26 to 1.18). In a sensitivity analysis including the two studies using the Amplatzer PFO occluder, TDC showed a possible protective effect on recurrent stroke compared with medical therapy (HR 0.38, 95% CI 0.14 to 1.02); however, it did not reach statistical significance. Safety analysis found that the overall risks for all-cause mortality and adverse events were similar in both the TDC and medical therapy groups. However, TDC increased the risk of new-onset atrial fibrillation (RR 3.50, 95% CI 1.47 to 8.35) and may be associated with the type of device used. AUTHORS' CONCLUSIONS The combined data from recent RCTs have shown no statistically significant differences between TDC and medical therapy in the prevention of recurrent ischemic stroke. TDC closure was associated with an increased risk of atrial fibrillation but not with serious adverse events.
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Affiliation(s)
- Jie Li
- People's Hospital of Deyang CityDepartment of NeurologyNo.173, Taishan North RoadDeyangSichuanChina618000
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Junfeng Liu
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Ming Liu
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Shihong Zhang
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Zilong Hao
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Jing Zhang
- Xuanwu Hospital, Capital Medical UniversityDepartment of NeurologyNo. 45, Changchun StreetBeijingBeijingChina100053
| | - Canfei Zhang
- The First Affiliated Hospital of Henan University of Science and TechnologyDepartment of NeurologyNo. 24, Jinghua RoadLuoyangHenan ProvinceChina471003
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Affiliation(s)
- Arjun K Ghosh
- Specialty Registrar in Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Ajay Jain
- Consultant Cardiologist at Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London
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8
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Pandit A, Aryal MR, Pandit AA, Jalota L, Kantharajpur S, Hakim FA, Lee HR. Amplatzer PFO occluder device may prevent recurrent stroke in patients with patent foramen ovale and cryptogenic stroke: a meta-analysis of randomised trials. Heart Lung Circ 2013; 23:303-8. [PMID: 24495944 DOI: 10.1016/j.hlc.2013.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/02/2013] [Accepted: 12/06/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review efficacy of percutaneous closure of patent foramen ovale compared with medical therapy in prevention of recurrent strokes in patients with cryptogenic stroke. METHODS AND RESULTS Electronic databases; PUBMED, EMBASE, Cochrane registry and web of knowledge were searched for relevant studies. In three randomised clinical trials involving 2303 participants, risk of the recurrent strokes (pooled HR 0.62, 95% CI=0.36-1.07, P=0.09, I(2) =10%) did not show benefit with device closure when compared with medical therapy group on meta-analysis of all three trials. However, on sensitivity analysis in trials using Amplatzer PFO occluder device, the closure of PFO was associated with significantly lower recurrent strokes (pooled HR=0.44, 95% CI=0.21-0.94, P=0.03, I(2)=0%) compared with medical therapy. CONCLUSION The closure of PFO with Amplatzer PFO occluder device was associated with significant reduction in recurrent strokes in patients with cryptogenic stroke and patent foramen ovale. The better outcome in prevention of secondary stroke in patients with cryptogenic stroke and PFO may be associated with type of closure device used.
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Affiliation(s)
- Anil Pandit
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA.
| | - Madan Raj Aryal
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA
| | | | - Leena Jalota
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA
| | | | - Fayaz A Hakim
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Howard R Lee
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
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Kwong JS, Lam YY, Yu CM. Percutaneous closure of patent foramen ovale for cryptogenic stroke: A meta-analysis of randomized controlled trials. Int J Cardiol 2013; 168:4132-8. [DOI: 10.1016/j.ijcard.2013.07.077] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 11/30/2022]
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Hakeem A, Marmagkiolis K, Hacioglu Y, Uretsky BF, Gundogdu B, Leesar M, Bailey SR, Cilingiroglu M. Safety and efficacy of device closure for patent foramen ovale for secondary prevention of neurological events: Comprehensive systematic review and meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:349-55. [PMID: 24080379 DOI: 10.1016/j.carrev.2013.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/13/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Controversy persists regarding the management of patients with cryptogenic stroke and patent foramen ovale (PFO). We performed a meta-analysis of randomized controlled trials comparing PFO closure with medical therapy. METHODS AND RESULTS A prospective protocol was developed and registered using the following data sources: PubMed, Cochrane Register of Controlled Trials, conference proceedings, and Internet-based resources of clinical trials. Primary analyses were performed using the intention-to-treat method. Three randomized trials comparing percutaneous PFO closure vs. medical therapy for secondary prevention of embolic neurological events formed the data set. Baseline characteristics were similar. During long-term follow-up, the pooled incidence of the primary endpoint (composite of stroke, death, or fatal stroke) was 3.4% in the PFO closure arm and 4.8% in the medical therapy group [risk-reduction (RR) 0.7 (0.48-1.06); p=0.09]. The incidence of recurrent neurological events (secondary endpoint) was 1.7% for PFO closure and 2.7% for medical therapy [RR 0.66 (0.35-1.24), p=0.19]. There was no difference in terms of death or adverse events between the two groups. CONCLUSIONS While this meta-analysis of randomized clinical trials demonstrated no statistical significance in comparison to medical therapy, there was a trend towards overall improvement in outcomes in the PFO closure group.
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Affiliation(s)
- Abdul Hakeem
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Management of the Stroke Patient with Patent Foramen Ovale: New Insights and Persistent Questions in the Wake of Recent Randomized Trials. Curr Atheroscler Rep 2013; 15:338. [DOI: 10.1007/s11883-013-0338-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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PFO Closure for Cryptogenic Stroke: Review of New Data and Results. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:360-71. [DOI: 10.1007/s11936-013-0243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kijima Y, Akagi T, Taniguchi M, Nakagawa K, Deguchi K, Tomii T, Kusano K, Sano S, Ito H. Catheter closure of atrial septal defect in patients with cryptogenic stroke: initial experience in Japan. Cardiovasc Interv Ther 2011; 27:8-13. [DOI: 10.1007/s12928-011-0075-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 06/28/2011] [Indexed: 11/29/2022]
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Yerlioglu E, Krishnamoorthy V, Jeon H, Gustin A, Nicolau-Raducu R. Patent foramen ovale and intracardiac thrombus identified by transesophageal echocardiography during liver transplantation. J Cardiothorac Vasc Anesth 2011; 26:1069-73. [PMID: 21757375 DOI: 10.1053/j.jvca.2011.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Indexed: 12/17/2022]
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[Neurology and cardiology: points of contact]. Rev Esp Cardiol 2011; 64:319-27. [PMID: 21411208 DOI: 10.1016/j.recesp.2010.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 01/16/2023]
Abstract
Strokes resulting from cardiac diseases, and cardiac abnormalities associated with neuromuscular disorders are examples of the many points of contact between neurology and cardiology. Approximately 20-30% of strokes are related to cardiac diseases, including atrial fibrillation, congestive heart failure, bacterial endocarditis, rheumatic and nonrheumatic valvular diseases, acute myocardial infarction with left ventricular thrombus, and cardiomyopathies associated with muscular dystrophies, among others. Strokes can also occur in the setting of cardiac interventions such as cardiac catheterization and coronary artery bypass procedures. Treatment to prevent recurrent stroke in any of these settings depends on the underlying etiology. Whereas anticoagulation with vitamin K antagonists is proven to be superior to acetylsalicylic acid for stroke prevention in atrial fibrillation, the superiority of anticoagulants has not been conclusively established for stroke associated with congestive heart failure and is contraindicated in those with infective endocarditis. Ongoing trials are evaluating management strategies in patients with atrial level shunts due to patent foramen ovale. Cardiomyopathies and conduction abnormalities are part of the spectrum of many neuromuscular disorders including mitochondrial disorders and muscular dystrophies. Cardiologists and neurologists share responsibility for caring for patients with or at risk for cardiogenic strokes, and for screening and managing the heart disease associated with neuromuscular disorders.
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Delgado V, van der Kley F, Schalij MJ, Bax JJ. Optimal imaging for planning and guiding interventions in structural heart disease: a multi-modality imaging approach. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
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Chandrashekhar Y. PFO and the heart more than meets the eye! JACC Cardiovasc Imaging 2010; 3:840-2. [PMID: 20705264 DOI: 10.1016/j.jcmg.2010.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
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Marsh JD, Keyrouz SG. Stroke Prevention and Treatment. J Am Coll Cardiol 2010; 56:683-91. [DOI: 10.1016/j.jacc.2009.12.072] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 12/01/2009] [Accepted: 12/07/2009] [Indexed: 11/15/2022]
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Spies C, Cao QL, Hijazi ZM. Transcatheter patent foramen ovale closure: review and choice of devices. Interv Cardiol 2010. [DOI: 10.2217/ica.10.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Michelena HI, Abel MD, Suri RM, Freeman WK, Click RL, Sundt TM, Schaff HV, Enriquez-Sarano M. Intraoperative echocardiography in valvular heart disease: an evidence-based appraisal. Mayo Clin Proc 2010; 85:646-55. [PMID: 20592170 PMCID: PMC2894720 DOI: 10.4065/mcp.2009.0629] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications.
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Affiliation(s)
- Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Ruygrok PN. The Coherex FlatStent: an advance in patent foramen ovale closure. Expert Rev Med Devices 2010; 7:193-9. [PMID: 20214425 DOI: 10.1586/erd.09.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A patent foramen ovale (PFO) is a remnant tunnel between the right and left atrium that has been found to be present more frequently in young patients with stroke and in sufferers of migraines. Percutaneous closure of the tunnel has become commonplace, replacing surgical closure. Various devices have been developed, most of which consist of atrial discs joined by a connecting wire. The Coherex FlatStent provides a new paradigm for PFO closure as it consists of a nitinol frame covered with polyurethane foam that is deployed within the PFO tunnel. Animal and Phase I and II studies have shown this device to be safe, effective and easy to use. More than 100 patients have now received such a device with excellent closure rates such that it may become an attractive and important development in patients with the clinical sequelae of PFO.
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Affiliation(s)
- Peter N Ruygrok
- Green Lane Cardiovascular Service, Level 3, Auckland City Hospital, Private Bag 92024, Victoria Street West, Auckland 1142, New Zealand.
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Ko R, Walker NE, Mullen MJ. Different patent foramen ovale closure techniques in varying anatomies. Interv Cardiol 2010. [DOI: 10.2217/ica.09.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Spies C, Wong M. Patent foramen ovale and cryptogenic stroke: a complex neuro-cardio-vascular problem. Expert Rev Cardiovasc Ther 2009; 7:1455-67. [PMID: 19900028 DOI: 10.1586/erc.09.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patent foramen ovale has been suggested to be a risk factor for cryptogenic stroke by means of paradoxical embolism. The data, however, are complex, conflicting and largely unavailable. In this review, we attempt to summarize the existing data separately for the questions of whether patent foramen ovale is associated with cryptogenic stroke and whether it is a risk factor for a first ischemic stroke and for recurrent strokes. Treatment options will be discussed, and the different viewpoints from the two specialists mainly involved in the care of those complex patients (neurologists and cardiologists) will be provided.
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Affiliation(s)
- Christian Spies
- The Queen's Medical Center, Queen's Heart Physician Practice, 550 S Beretania Street, Suite 300, Honolulu, HI 96813, USA.
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