{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:03:07Z","timestamp":1791925387688,"version":"4.3.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Patent foramen ovale (PFO)-closure is recommended for stroke prevention in selected patients with suspected PFO-associated stroke. However, studies on cerebrovascular event recurrence after PFO-closure are limited by relatively short follow-up periods and information on the underlying aetiology of recurrent events is scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>All consecutive patients with a cerebral ischaemic event and PFO-closure at the University Hospital Graz were prospectively identified from 2004 to 2021. Indication for PFO-closure was based on a neurological-cardiological PFO board decision. Patients underwent standardized clinical and echocardiographic follow-up 6\u2009months after PFO-closure. Recurrent cerebrovascular events were assessed via electronical health records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>PFO-closure was performed in 515 patients (median age: 49\u2009years; Amplatzer PFO occluder: 42%). Over a median follow-up of 11\u2009years (range: 2\u201318\u2009years, 5141 total patient-years), recurrent ischaemic cerebrovascular events were observed in 34 patients (ischaemic stroke: n\u2009=\u200922, TIA: n\u2009=\u200912) and associated with age, hyperlipidaemia and smoking in multivariable analysis (p\u2009&amp;lt;\u20090.05 each). Large artery atherosclerosis and small vessel disease were the most frequent aetiologies of recurrent stroke\/TIA (27% and 24% respectively), and only two events were related to atrial fibrillation (AF). Recurrent ischaemic cerebrovascular event rates and incident AF were comparable in patients treated with different PFO occluders (p\u2009&amp;gt;\u20090.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion:<\/jats:title>\n                    <jats:p>In this long-term follow-up-study of patients with a cerebral ischaemic event who had received PFO-closure with different devices, rates of recurrent stroke\/TIA were low and largely related to large artery atherosclerosis and small vessel disease. Thorough vascular risk factor control seems crucial for secondary stroke prevention in patients treated for PFO-related stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873231197564","type":"journal-article","created":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T04:14:07Z","timestamp":1693628047000},"page":"1021-1029","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Long-term risk of recurrent cerebrovascular events after patent foramen ovale closure: Results from a real-world stroke cohort"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6334-9432","authenticated-orcid":false,"given":"Markus","family":"Kneihsl","sequence":"first","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"},{"name":"Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Horner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5062-9558","authenticated-orcid":false,"given":"Isra","family":"Hatab","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Sch\u00f6ngrundner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diether","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Information and Process Management, Steierm\u00e4rkische Krankenanstaltengesellschaft m.b.H. (KAGes), Graz, Austria 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Toth-Gayor","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Medical University Graz, Graz, Austria 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"Grangl","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerit","family":"W\u00fcnsch","sequence":"additional","affiliation":[{"name":"Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9043-0378","authenticated-orcid":false,"given":"Simon","family":"Fandler-H\u00f6fler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Haidegger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai","family":"Veeranki","sequence":"additional","affiliation":[{"name":"Department of Information and Process Management, Steierm\u00e4rkische Krankenanstaltengesellschaft m.b.H. (KAGes), Graz, Austria 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland 7"},{"name":"Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 8"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Enzinger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gattringer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz, Graz, Austria 1"},{"name":"Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria 2"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"2026012113102314300_bibr1-23969873231197564","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","article-title":"Embolic strokes of undetermined source: the case for a new clinical construct","volume":"13","author":"Hart","year":"2014","journal-title":"Lancet Neurol"},{"key":"2026012113102314300_bibr2-23969873231197564","doi-asserted-by":"crossref","first-page":"653","DOI":"10.3389\/fneur.2020.00653","article-title":"It\u2019s time to say goodbye to the ESUS construct","volume":"11","author":"Fuentes","year":"2020","journal-title":"Front Neurol"},{"key":"2026012113102314300_bibr3-23969873231197564","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1056\/NEJMoa1610057","article-title":"Long-term outcomes of patent foramen ovale closure or medical therapy after stroke","volume":"377","author":"Saver","year":"2017","journal-title":"N Engl J Med"},{"key":"2026012113102314300_bibr4-23969873231197564","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1056\/NEJMoa1707404","article-title":"Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke","volume":"377","author":"S\u00f8ndergaard","year":"2017","journal-title":"N Engl J Med"},{"key":"2026012113102314300_bibr5-23969873231197564","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMoa1705915","article-title":"Patent foramen ovale closure or anticoagulation vs. Antiplatelets after stroke","volume":"377","author":"Mas","year":"2017","journal-title":"N Engl J Med"},{"key":"2026012113102314300_bibr6-23969873231197564","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.008356","article-title":"Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke with patent foramen ovale: systematic review of randomized trials, sequential meta-analysis, and new insights from the CLOSE study","volume":"7","author":"Turc","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2026012113102314300_bibr7-23969873231197564","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American heart association\/American stroke association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"2026012113102314300_bibr8-23969873231197564","doi-asserted-by":"crossref","first-page":"3182","DOI":"10.1093\/eurheartj\/ehy649","article-title":"European position paper on the management of patients with patent foramen ovale. 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