Interventional prevention of paradoxical embolism as the gold standard: End of discussion?

Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available d...

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Autores principales:	Radomir Nykl, Jan Precek, Martin Sluka, Stepan Hudec, David Richter, Petr Heinc, Milos Taborsky
Formato:	article
Lenguaje:	EN
Publicado:	Palacký University Olomouc, Faculty of Medicine and Dentistry 2021
Materias:	paradoxical embolism patent foramen ovale interatrial septal aneurysm catheterization pfo closure Medicine R
Acceso en línea:	https://doaj.org/article/9331d3ad0b694fe1876c7e1cfcd77aa9
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spelling	oai:doaj.org-article:9331d3ad0b694fe1876c7e1cfcd77aa92021-11-29T08:47:12ZInterventional prevention of paradoxical embolism as the gold standard: End of discussion?1213-81181804-752110.5507/bp.2021.036https://doaj.org/article/9331d3ad0b694fe1876c7e1cfcd77aa92021-09-01T00:00:00Zhttps://biomed.papers.upol.cz/artkey/bio-202103-0002_interventional-prevention-of-paradoxical-embolism-as-the-gold-standard-end-of-discussion.phphttps://doaj.org/toc/1213-8118https://doaj.org/toc/1804-7521Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.Radomir NyklJan PrecekMartin SlukaStepan HudecDavid RichterPetr HeincMilos TaborskyPalacký University Olomouc, Faculty of Medicine and Dentistryarticleparadoxical embolismpatent foramen ovaleinteratrial septal aneurysmcatheterization pfo closureMedicineRENBiomedical Papers, Vol 165, Iss 3, Pp 241-248 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	paradoxical embolism patent foramen ovale interatrial septal aneurysm catheterization pfo closure Medicine R
spellingShingle	paradoxical embolism patent foramen ovale interatrial septal aneurysm catheterization pfo closure Medicine R Radomir Nykl Jan Precek Martin Sluka Stepan Hudec David Richter Petr Heinc Milos Taborsky Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
description	Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.
format	article
author	Radomir Nykl Jan Precek Martin Sluka Stepan Hudec David Richter Petr Heinc Milos Taborsky
author_facet	Radomir Nykl Jan Precek Martin Sluka Stepan Hudec David Richter Petr Heinc Milos Taborsky
author_sort	Radomir Nykl
title	Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
title_short	Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
title_full	Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
title_fullStr	Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
title_full_unstemmed	Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
title_sort	interventional prevention of paradoxical embolism as the gold standard: end of discussion?
publisher	Palacký University Olomouc, Faculty of Medicine and Dentistry
publishDate	2021
url	https://doaj.org/article/9331d3ad0b694fe1876c7e1cfcd77aa9
work_keys_str_mv	AT radomirnykl interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion AT janprecek interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion AT martinsluka interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion AT stepanhudec interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion AT davidrichter interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion AT petrheinc interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion AT milostaborsky interventionalpreventionofparadoxicalembolismasthegoldstandardendofdiscussion
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Interventional prevention of paradoxical embolism as the gold standard: End of discussion?

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