title: A model of multi-disciplinary approach to the diagnosis and treatment of young patients with cryptogenic stroke and patent foramen ovale.
abstract: BACKGROUND
  Treatment of patent foramen ovale in young patients with stroke is not supported by robust scientific evidence. In clinical practice, a pragmatic approach is needed to guide such therapeutic decisions. This study aims at standardising the diagnostic pathway for stroke patients younger than 55 years of age with a patent foramen ovale; elaborating a therapeutic algorithm; discussing every case in regular interdisciplinary counselling meeting; and setting up a follow-up schedule to assess clinical outcomes.
  
  
  METHODS
  This is a cohort study on the effect of a standardised treatment of stroke patients with a patent foramen ovale. The primary endpoints include occurrence of recurrent ischaemic events, major bleeding, and device-related complications. The secondary endpoints include drug- or procedure-related side effects, persistence of right-to-left shunt, and persistent cardiac arrhythmia of new onset.
  
  
  RESULTS
  A total of 103 patients have been enrolled. In all, 51 patients underwent percutaneous atrial septal repair; of these, one had minor post-procedural bleeding. At 12 months, 25% of this group of patients showed a latent I grade shunt, one patient a latent II degree shunt, and none had a persistent shunt. The remaining 52 patients were addressed to medical therapy; one of them experienced stroke recurrences while on medical therapy.
  
  
  CONCLUSIONS
  This model of implementation of available evidence to clinical practice via a group-based, multi-disciplinary counselling provides a shared and coherent decision pathway and yielded a very low rate of recurrent events and therapy-related complications. This approach could be replicated in specific protocols for other complex or neglected clinical problems.
authors.affiliation: Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy. sara.mazzucco@univr.it
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzucco
authors.forename: Paolo
authors.initials: P
authors.lastname: Bovi
authors.forename: Monica
authors.initials: M
authors.lastname: Carletti
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tomelleri
authors.forename: Giorgio
authors.initials: G
authors.lastname: Golia
authors.forename: Chiara
authors.initials: C
authors.lastname: Stegagno
authors.forename: Andrea
authors.initials: A
authors.lastname: Variola
authors.forename: Maurizio
authors.initials: M
authors.lastname: Anselmi
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolis
authors.forename: Silvia
authors.initials: S
authors.lastname: Olivato
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Anzola
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
mesh_terms: D000328:Adult; D000465:Algorithms; D002985:Clinical Protocols; D003661:Decision Support Techniques; D015150:Echocardiography, Doppler; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D033183:Interdisciplinary Communication; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000628:therapy; D007558:Italy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D015996:Survival Rate