{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:56:19Z","timestamp":1778270179719,"version":"3.51.4"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,5,4]],"date-time":"2018-05-04T00:00:00Z","timestamp":1525392000000},"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>To examine long\u2010term clinical outcomes with transcatheter patent foramen ovale (PFO) closure versus medical therapy alone in patients with cryptogenic stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>A long\u2010standing debate regarding the optimal approach for the management of patients with PFO after a cryptogenic stroke exists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An electronic search was performed for randomized clinical trials (RCTs) reporting clinical outcomes with PFO closure vs. medical therapy alone after stroke. Random effects DerSimonian\u2010Laird risk ratios (RR) were calculated. The main outcome was recurrence of stroke. Other outcomes included transient ischemic attack (TIA), new\u2010onset atrial fibrillation\/flutter (AF\/AFL), major bleeding, serious adverse events, and device\u2010related complications. All\u2010cause mortality was also examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five RCTs with a total of 3,440 patients were included. At a mean follow\u2010up of 4.02\u2009\u00b1\u20091.57 years, PFO closure was associated with less recurrence of stroke (RR\u2009=\u20090.43; 95% CI 0.19\u20130.91; <jats:italic>P<\/jats:italic>\u2009=\u2009.027) compared with medical therapy alone. No difference was observed between both strategies for TIA (<jats:italic>P<\/jats:italic>\u2009=\u2009.21), major bleeding (<jats:italic>P<\/jats:italic>\u2009=\u2009.69), serious adverse events (<jats:italic>P<\/jats:italic>\u2009=\u2009.35), and all\u2010cause death (<jats:italic>P<\/jats:italic>\u2009=\u2009.48). However, PFO closure, was associated with increased new\u2010onset AF\/AFL (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001), risk of pulmonary embolism (<jats:italic>P<\/jats:italic>\u2009=\u2009.04), and device\u2010related complications (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). On a subgroup analysis, stroke recurrence rate remained lower in PFO closure arm regardless of the type of closure device used (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u2009.50), or the presence of substantial shunt in the majority of study population (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u2009.13).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Transcatheter PFO closure reduces the recurrence of stroke compared with medical therapy alone, with no significant safety concerns. Close follow\u2010up of patients after PFO closure is recommended to detect new\u2010onset atrial arrhythmias.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.27636","type":"journal-article","created":{"date-parts":[[2018,5,4]],"date-time":"2018-05-04T10:31:10Z","timestamp":1525429870000},"page":"176-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Long\u2010term outcomes of patent foramen ovale closure or medical therapy after cryptogenic stroke: A meta\u2010analysis of randomized trials"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5165-9919","authenticated-orcid":false,"given":"Hesham K.","family":"Abdelaziz","sequence":"first","affiliation":[{"name":"Lancashire Cardiac Center Blackpool Victoria Hospital Blackpool United Kingdom"},{"name":"Division of Cardiovascular Medicine Ain Shams University Cairo 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California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-2652","authenticated-orcid":false,"given":"Naga Venkata K.","family":"Pothineni","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Arkansas for Medical Sciences Little Rock Arkansas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed E.","family":"Madmani","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Arkansas for Medical Sciences Little Rock Arkansas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Lancashire Cardiac Center Blackpool Victoria Hospital Blackpool United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehtisham","family":"Mahmud","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of 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