Patent foramen ovale closure versus medical therapy alone in elderly patients with cryptogenic stroke: a systematic review and meta-analysis.
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| Title: | Patent foramen ovale closure versus medical therapy alone in elderly patients with cryptogenic stroke: a systematic review and meta-analysis. |
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| Authors: | de Deus, Ocilio (AUTHOR), Tudella, Gabriel Caruso Novaes (AUTHOR), Pereira, Maria Antonia Oliveira Machado (AUTHOR), Menegucci, Giovana (AUTHOR), Klostermann, Augusto Utida (AUTHOR), Pereira da Silva, Anderson Matheus (AUTHOR), Mitre, Lucas Pari (AUTHOR), Scarcia, Luca (AUTHOR), Günkan, Ahmet (AUTHOR), Nguyen, Thanh (AUTHOR) |
| Source: | Neurological Sciences. Apr2026, Vol. 47 Issue 4, p1-11. 11p. |
| Abstract: | Introduction: Current guideline recommendations from American Heart Association/American Stroke Association (AHA/ASA) strongly favor percutaneous patent foramen ovale closure (PFOC) over medical therapy alone only for younger patients aged 18–60 years with a prior cryptogenic stroke (CS). However, for patients aged ≥ 60 years, evidence remains limited and uncertain. Objective: To evaluate the efficacy and safety of PFOC with background medical therapy compared with medical therapy alone in elderly (≥ 60 years) patients with CS. Methods: We systematically searched PubMed, Embase, and Cochrane Library from inception to August 2025. We restricted inclusion in this study to articles that met all the following eligibility criteria: (1) RCTs and comparative retrospective or prospective observational studies; (2) that enrolled elderly (≥ 60 years) participants diagnosed with CS. The primary outcome was defined as recurrent IS or TIA in the follow-up after PFOC or initiation of medical therapy alone. The safety outcomes were defined as: (1) all-cause mortality in the follow-up, (2) development of new onset atrial fibrillation (AF)/flutter and (3) major bleeding events. All statistical analyses were performed using R Studio version 4.3.2. We employed a risk ratio (RR) with 95% confidence intervals (CIs) as the measure of effect size to report binary outcomes with p-value lower than 0.05 to achieve statistical significance. Results: Seven observational studies were included. Publication years ranged from 2012 to 2025. A total of 6,725 patients were enrolled including 1,636 (24.3%) in the PFOC group and 5,089 (75.7%) in the medical therapy alone group. PFOC showed statistically significantly lower rates of recurrent ischemic stroke or TIA (RR 0.49; 95% CI: 0.35–0.67; p < 0.001; I² = 3.2%) and all-cause mortality compared to medical therapy alone (RR 0.39; 95% CI: 0.18–0.87; p = 0.022; I² = 22.0%). PFOC showed no statistically significant difference compared to medical therapy alone regarding new onset atrial fibrillation or atrial flutter (RR 1.38; 95% CI: 0.60–3.15; p = 0.448; I² = 66.3%) and major bleeding (RR 0.99; 95% CI: 0.44–2.24; p = 0.977; I² = 19.9%). Conclusion: This meta-analysis findings suggest that selected patients aged ≥ 60 years with CS may derive benefit from PFOC, with reductions in recurrent cerebrovascular ischemic events and mortality, without an excess risk of new onset AF/flutter or major bleeding compared to medical therapy alone. [ABSTRACT FROM AUTHOR] |
| Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 192707459 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Patent foramen ovale closure versus medical therapy alone in elderly patients with cryptogenic stroke: a systematic review and meta-analysis. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22de+Deus%2C+Ocilio%22">de Deus, Ocilio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tudella%2C+Gabriel+Caruso+Novaes%22">Tudella, Gabriel Caruso Novaes</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pereira%2C+Maria+Antonia+Oliveira+Machado%22">Pereira, Maria Antonia Oliveira Machado</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Menegucci%2C+Giovana%22">Menegucci, Giovana</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Klostermann%2C+Augusto+Utida%22">Klostermann, Augusto Utida</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pereira+da+Silva%2C+Anderson+Matheus%22">Pereira da Silva, Anderson Matheus</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mitre%2C+Lucas+Pari%22">Mitre, Lucas Pari</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Scarcia%2C+Luca%22">Scarcia, Luca</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Günkan%2C+Ahmet%22">Günkan, Ahmet</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nguyen%2C+Thanh%22">Nguyen, Thanh</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Neurological+Sciences%22">Neurological Sciences</searchLink>. Apr2026, Vol. 47 Issue 4, p1-11. 11p. – Name: Abstract Label: Abstract Group: Ab Data: Introduction: Current guideline recommendations from American Heart Association/American Stroke Association (AHA/ASA) strongly favor percutaneous patent foramen ovale closure (PFOC) over medical therapy alone only for younger patients aged 18–60 years with a prior cryptogenic stroke (CS). However, for patients aged ≥ 60 years, evidence remains limited and uncertain. Objective: To evaluate the efficacy and safety of PFOC with background medical therapy compared with medical therapy alone in elderly (≥ 60 years) patients with CS. Methods: We systematically searched PubMed, Embase, and Cochrane Library from inception to August 2025. We restricted inclusion in this study to articles that met all the following eligibility criteria: (1) RCTs and comparative retrospective or prospective observational studies; (2) that enrolled elderly (≥ 60 years) participants diagnosed with CS. The primary outcome was defined as recurrent IS or TIA in the follow-up after PFOC or initiation of medical therapy alone. The safety outcomes were defined as: (1) all-cause mortality in the follow-up, (2) development of new onset atrial fibrillation (AF)/flutter and (3) major bleeding events. All statistical analyses were performed using R Studio version 4.3.2. We employed a risk ratio (RR) with 95% confidence intervals (CIs) as the measure of effect size to report binary outcomes with p-value lower than 0.05 to achieve statistical significance. Results: Seven observational studies were included. Publication years ranged from 2012 to 2025. A total of 6,725 patients were enrolled including 1,636 (24.3%) in the PFOC group and 5,089 (75.7%) in the medical therapy alone group. PFOC showed statistically significantly lower rates of recurrent ischemic stroke or TIA (RR 0.49; 95% CI: 0.35–0.67; p < 0.001; I² = 3.2%) and all-cause mortality compared to medical therapy alone (RR 0.39; 95% CI: 0.18–0.87; p = 0.022; I² = 22.0%). PFOC showed no statistically significant difference compared to medical therapy alone regarding new onset atrial fibrillation or atrial flutter (RR 1.38; 95% CI: 0.60–3.15; p = 0.448; I² = 66.3%) and major bleeding (RR 0.99; 95% CI: 0.44–2.24; p = 0.977; I² = 19.9%). Conclusion: This meta-analysis findings suggest that selected patients aged ≥ 60 years with CS may derive benefit from PFOC, with reductions in recurrent cerebrovascular ischemic events and mortality, without an excess risk of new onset AF/flutter or major bleeding compared to medical therapy alone. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10072-026-08980-y Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 11 StartPage: 1 Titles: – TitleFull: Patent foramen ovale closure versus medical therapy alone in elderly patients with cryptogenic stroke: a systematic review and meta-analysis. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: de Deus, Ocilio – PersonEntity: Name: NameFull: Tudella, Gabriel Caruso Novaes – PersonEntity: Name: NameFull: Pereira, Maria Antonia Oliveira Machado – PersonEntity: Name: NameFull: Menegucci, Giovana – PersonEntity: Name: NameFull: Klostermann, Augusto Utida – PersonEntity: Name: NameFull: Pereira da Silva, Anderson Matheus – PersonEntity: Name: NameFull: Mitre, Lucas Pari – PersonEntity: Name: NameFull: Scarcia, Luca – PersonEntity: Name: NameFull: Günkan, Ahmet – PersonEntity: Name: NameFull: Nguyen, Thanh IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 04 Text: Apr2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 15901874 Numbering: – Type: volume Value: 47 – Type: issue Value: 4 Titles: – TitleFull: Neurological Sciences Type: main |
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