A Systematic Review Of Closure Versus Medical Therapy For Preventing Recurrent Stroke In Patients With Patent Foramen Ovale And Cryptogenic Stroke

Background This systematic review was aimed to synthesize the results ofrandomized controlled trials to compare the safety and efficacy between medicaltherapy and transcatheter closure of patent foramen ovale (PFO) for theprevention of recurrent stroke in patients with PFO and cryptogenic stroke.Methods The following databases were retrieved: the Cochrane CentralRegister of Controlled Trials, Embase, Pubmed, Web of Science,ClinicalTrials.gov, WanFang, WeiPu, CNKI and CMB. Besides, we manuallysearched several kinds of neurological journals, and reviewed all the referencesof relevant reviews and clinical trials for the potential trials. All the inclusiontrials were randomized controlled designed. Meta-analyses were performed viathe soft of Review Manager5.2.Results Three randomized controlled trials with a total of2303patientswere included and analyzed. No significant difference was observed in primaryoutcome of a composite of recurrent stroke and TIA (RR=0.71,95%CI=0.47 to1.05, p=0.09).There were no significant difference between two groups inthe adverse events (RR=1.08,95%CI=0.93-1.26, P=0.32). Sensitivity analysisand subgroup analysis suggested that patients existing large shunt or operatingwith Amplatzer occluder might benefit from PFO closure, but the results wasunstable.Conclusions There is not enough evidence to demonstrate thattranscatheter closure of PFO is superior to medical therapy in the secondaryprevention of patients with PFO and cryptogenic stroke. PFO closure has thesame security with medical therapy in the secondary prevention of cryptogenicstroke.