Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

PFO Closure Linked with Reduced Recurrent Stroke

J Stroke Cerebrovasc Dis; ePub 2018 May 24; Garg, et al

Endovascular patent foramen ovale (PFO) closure was associated with a reduced risk of recurrent stroke in patients with a prior cryptogenic cerebral infarct, according to a recent meta-analysis. A systematic literature search was undertaken that included published pooled data from 5 large randomized clinical trials, which were combined and then subsequently analyzed. Enrolled patients with cryptogenic stroke were assigned to receive standard medical care or to undergo endovascular PFO closure, with a primary outcome of reduction in stroke recurrence rate. Secondary outcomes included rates of transient ischemic attack (TIA), composite outcome of stroke, TIA, and death from all causes, and rates of atrial fibrillation events. Researchers analyzed data for 3,412 patients and found:

  • Transcatheter PFO closure resulted in a statistically significant reduced rate of recurrent stroke, compared with medication alone.
  • Patients undergoing closure were 58% less likely to have another stroke.
  • The number needed to treat with PFO closure to reduce recurrent stroke for 1 patient was 40.


Garg L, Haleem A, Varade S, et al. Patent foramen ovale closure in the setting of cryptogenic stroke: A meta-analysis of five randomized trials. [Published online ahead of print May 24, 2018]. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2018.05.005.

This Week's Must Reads

Midlife Risk Factors Linked to Late-Onset Epilepsy, JAMA Neurology; ePub 2018 Jul 23; Johnson, et al

Nearly 1 Million Adults ≥55 Years Have Epilepsy, Epilepsy Behav; ePub 2018 Aug 2; Sapkota, et al

Incidental Findings Common in Stroke Patients, J Stroke Cerebrovasc Dis; ePub 2018 Aug 2; Doyle, et al

Spatial Heterogeneity of White Matter Lesions , Neurology; ePub 2018 Aug 3; Habes, et al

Poor Sleep Linked to Slow Recovery from TBI, Sleep; ePub 2018 Jul 24; Kalmbach, Conroy, et al

Must Reads in Stroke

Blood Pressure Drugs Lower Recurrent Stroke Risk, Cochrane; 2018 Jul 19; Zonneveld, Richard, et al

BP Variability Leads to Worse Outcome After Stroke, Stroke; ePub 2018 Jul 16; de Havenon, Majersik, et al

Readmission Rates After Thrombectomy for Stroke , J Stroke Cerebrovasc Dis; ePub 2018 Jul 3; Ramchand, et al

FDA Approves Xeomin for Excessive Drooling, Merz North America news release; 2018 Jul 3

Black Race Not Independently Linked to Microbleeds, J Stroke Cerebrovasc Dis; ePub 2018 Jun 23; Noorbakhsh-Sabet, et al