{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T06:43:33Z","timestamp":1777531413031,"version":"3.51.4"},"reference-count":27,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:00:00Z","timestamp":1658880000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Whether atrial septal aneurysm (ASA) increases the risk of cerebrovascular ischemic events in patients with patent foramen ovale (PFO) remains controversial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We constructed a detailed meta\u2010analysis to assess the effect of ASA on risk of cerebrovascular ischemic events in patients with PFO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomized controlled trials (RCTs) and observational studies (cohort studies and case\u2010control studies) that compared PFO\u2010ASA against PFO alone were included. Pooled odds ratios (OR) estimates and 95% CI were calculated using the fixed\u2010effect and random\u2010effect models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four RCTs and twelve observational studies (five cohort studies and seven case\u2010control studies) contributed to the meta\u2010analysis. The pooled results of case\u2010control studies showed that ASA increased the risk of cerebrovascular ischemic events in patients with PFO (fixed\u2010effect model: OR = 3.69; 95% CI: 2.67\u20135.09;<jats:italic>p<\/jats:italic>&lt; 0.01, random\u2010effect model: OR = 3.63; 95% CI: 2.51\u20135.24;<jats:italic>p<\/jats:italic>&lt; 0.01). However, poole results from RCTs (fixed\u2010effect model: OR = 1.24; 95% CI: 0.78\u20131.95;<jats:italic>p<\/jats:italic>= 0.36, random\u2010effect model: OR = 1.27; 95% CI: 0.78\u20132.08;<jats:italic>p<\/jats:italic>= 0.34) and cohort studies (fixed\u2010effect model: OR = 1.35; 95% CI: 0.81\u20132.23;<jats:italic>p<\/jats:italic>= 0.25, random\u2010effect model: OR = 1.40; 95% CI: 0.84\u20132.33;<jats:italic>p<\/jats:italic>= 0.20) found no evidence. Overall analysis showed that ASA increased the risk of cerebrovascular ischemic events (fixed\u2010effect model: OR = 2.30; 95% CI: 1.84\u20132.87;<jats:italic>p<\/jats:italic>&lt; 0.01, random\u2010effect model: OR = 2.11; 95% CI: 1.48\u20133.01;<jats:italic>p<\/jats:italic>&lt; 0.01). The sensitivity analysis confirmed the stability of all results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although case\u2010control studies support ASA to increase the risk of cerebrovascular ischemic events in patients with PFO, RCTs and cohort studies challenged the credibility. Further prospective studies are needed to confirm the effect of ASA on patients with PFO.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51638","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T12:08:52Z","timestamp":1658923732000},"page":"1384-1391","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of<scp>ASA<\/scp>on the risk of cerebrovascular ischemic events in patients with<scp>PFO<\/scp>"],"prefix":"10.1002","volume":"9","author":[{"given":"Liang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Ultrasound The First College of Clinical Medical Sciences, China Three Gorges University Yichang Hubei Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3899-690X","authenticated-orcid":false,"given":"Chang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The First College of Clinical Medical Sciences, China Three Gorges University Yichang Hubei Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0533-3739","authenticated-orcid":false,"given":"Xuemei","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The Third People's Hospital of Yichang City Yichang Hubei Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The First College of Clinical Medical Sciences, China Three Gorges University Yichang Hubei Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The First College of Clinical Medical Sciences, China Three Gorges University Yichang Hubei Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The First College of Clinical Medical Sciences, China Three Gorges University Yichang Hubei Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,7,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1111\/ene.12228","article-title":"Etiology of first ever ischaemic stroke in European young adults: the 15 cities young stroke study","volume":"20","author":"Barlas NY","year":"2013","journal-title":"Eur J Neurol"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2008.02903.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a08d59"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705915"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2019.03.021"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.521427"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000017498.88393.44"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"e_1_2_9_10_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [Updated March 2011]","author":"Higgins JPT","year":"2011"},{"key":"e_1_2_9_11_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Metaanalyses","author":"Wells GA","year":"2013"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009639"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1211716"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610057"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.05.044"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.030494"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-006-0524-z"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011503"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2021.07.016"},{"key":"e_1_2_9_20_1","first-page":"1258","article-title":"Transoesophageal echocardiography can help distinguish between patients with \"symptomatic\" and \"asymptomatic\" patent foramen ovale","volume":"70","author":"Komar K","year":"2012","journal-title":"Kardiol Pol"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.01.036"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.08.036"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1067\/mje.2003.34"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu143"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v11.i4.0000"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2022.02.006"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90750-1"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.8.1172"}],"container-title":["Annals of Clinical and Translational Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acn3.51638","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acn3.51638","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acn3.51638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,25]],"date-time":"2023-11-25T00:56:01Z","timestamp":1700873761000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acn3.51638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,27]]},"references-count":27,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1002\/acn3.51638"],"URL":"https:\/\/doi.org\/10.1002\/acn3.51638","archive":["Portico"],"relation":{},"ISSN":["2328-9503","2328-9503"],"issn-type":[{"value":"2328-9503","type":"print"},{"value":"2328-9503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,27]]},"assertion":[{"value":"2022-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}