{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:06:27Z","timestamp":1788285987867,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T00:00:00Z","timestamp":1522368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We performed a systematic review and meta\u2010analysis of randomized controlled trials to assess the effect of closure of a patent foramen ovale (PFO) compared with medical therapy for the prevention of stroke in patients with prior cryptogenic stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>The role of PFO closure in reducing risk of stroke in patients with prior cryptogenic stroke has been controversial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, Embase, CINAHL, and CENTRAL for randomized trials investigating PFO closure versus medical therapy. We assessed trial bias and the quality of evidence for main outcomes was rated using GRADE. The primary outcome of interest was the occurrence of stroke. Estimates of effect were pooled with a random\u2010effects model. This study is registered with PROSPERO (CRD42017081579).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included five trials, comprising data for 3,440 adults randomized to receive PFO closure (<jats:italic>n<\/jats:italic>\u2009=\u20091,829) or medical therapy (<jats:italic>n<\/jats:italic>\u2009=\u20091,611). Mean follow\u2010up ranged from 2 years to 5.4 years across the trials. Patients treated with PFO closure had a lower risk of stroke (RR 0.39, 95% CI 0.18\u20130.88, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200957%, <jats:italic>P<\/jats:italic>\u2009=\u20090.02) compared with those treated with medical therapy. Subgroup analyses showed that the beneficial effect of PFO closure on a composite outcome of cerebrovascular events is more pronounced in patients with a large PFO shunt (RR 0.25, 95% CI 0.12\u20130.54, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%, <jats:italic>P<\/jats:italic>\u2009=\u20090.0004), male patients (RR 0.34, 95% CI 0.15\u20130.75, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200936%, <jats:italic>P<\/jats:italic>\u2009=\u20090.07), and those aged \u226445 years (RR 0.35, 95% CI 0.15\u20130.79, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%, <jats:italic>P<\/jats:italic>\u2009=\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PFO closure reduced risk of stroke compared with medical therapy. PFO closure is a therapeutic option that should be offered to adults with cryptogenic stroke.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.27615","type":"journal-article","created":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T23:50:03Z","timestamp":1522453803000},"page":"165-173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Patent foramen ovale (PFO) closure versus medical therapy for prevention of recurrent stroke in patients with prior cryptogenic stroke: A systematic review and meta\u2010analysis of randomized controlled trials"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5418-3728","authenticated-orcid":false,"given":"Anthony K.","family":"Akobeng","sequence":"first","affiliation":[{"name":"Systematic Review Unit, Sidra Medicine Doha Qatar"},{"name":"Weill Cornell Medical College Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtihal","family":"Abdelgadir","sequence":"additional","affiliation":[{"name":"Systematic Review Unit, Sidra Medicine Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3974-2696","authenticated-orcid":false,"given":"Younes","family":"Boudjemline","sequence":"additional","affiliation":[{"name":"Division of Cardiology Sidra Medicine Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyad M.","family":"Hijazi","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College Doha Qatar"},{"name":"Division of Cardiology Sidra Medicine Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000017498.88393.44"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198805053181802"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2012.00843.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.5152\/npa.2015.10034"},{"key":"e_1_2_8_6_1","first-page":"1666","article-title":"Patent foramen ovale and stroke","volume":"80","author":"Sung YP","year":"2016","journal-title":"Circulation J"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009639"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1211716"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301440"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002961"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009938.pub2"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705915"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707404"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610057"},{"key":"e_1_2_8_15_1","first-page":"g7647","article-title":"Preferred reporting items for systematic review and meta\u2010analysis protocols (PRISMA\u2010P) 2015: Elaboration and explanation","volume":"350","author":"Moher D","year":"2015","journal-title":"BMJ"},{"key":"e_1_2_8_16_1","series-title":"The Cochrane Collaboration","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_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39490.551019.BE"},{"key":"e_1_2_8_18_1","series-title":"The Cochrane Collaboration","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011)","author":"Sch\u00fcnemann HJ","year":"2011"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_8_21_1","series-title":"The Cochrane Collaboration","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011)","author":"Sch\u00fcnemann HJ","year":"2011"},{"key":"e_1_2_8_22_1","unstructured":"CatesC VisualR.Version 4 2016. 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