title: Secondary stroke prevention: patent foramen ovale, aortic plaque, and carotid stenosis.
abstract: Stroke is the most debilitating cardiovascular event. It has a variety of causes that may be present simultaneously. In young or otherwise healthy people, the search for a patent foramen ovale (PFO) has become standard. In stroke of the elderly, atherosclerosis and atrial fibrillation are in the foreground but the PFO should not be ignored. The risk of a PFO-related stroke over time is controversial and so is its prevention by device closure. The association of proximal aortic plaques in arteries subtending the brain and stroke is considered strong, ignoring that it is as putative as that of the PFO. Statins can prevent progression of such plaques. Antiplatelet agents in asymptomatic and surgical endarterectomy in symptomatic patients or highly ulcerated lesions are the treatment of choice. Stenting with protection devices was shown competitive in selected patients.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital Bern, 3010 Bern, Switzerland. bernhard.meier@insel.ch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Benedikt
authors.initials: B
authors.lastname: Frank
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahl
authors.forename: Hans C
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001018:Aortic Diseases / Q000150:complications; D021721:Balloon Occlusion / Q000379:methods; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D058226:Plaque, Atherosclerotic / Q000150:complications; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D055989:Septal Occluder Device; D015607:Stents; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors