Ischaemic stroke with patent foramen ovale.
BACKGROUND
There is no sound scientific documentation of current guidelines for the treatment of cerebral infarction assumed to be due to patent foramen ovale. In this article, we present a young patient with this condition. In addition, we provide a general overview of the prevalence, recommended assessment and indications for treatment of patent foramen ovale in ischaemic stroke patients.


METHODS
The article is based on a non-systematic search in PubMed. We emphasise three recently published randomised trials on the subject.


RESULTS
Transoesophageal echocardiography with saline contrast is the gold standard for detecting patent foramen ovale. Just who will benefit from the diagnosis and treatment of this condition remains unclear, however. None of the three randomised studies of antithrombotic treatment versus transcatheter closure in patients who have suffered ischaemic stroke show a difference in outcomes, but subgroup analyses indicate that closure in young patients (age <50 years) with a large foramen ovale reduces the number of recurrent ischaemic events. Two other randomised studies of antithrombotic treatment alone versus closure are presently ongoing.


CONCLUSIONS
For stroke patients with patent foramen ovale, the choice between lifelong antithrombotic therapy alone and transcatheter closure is a difficult one. Treatment with antiplatelet agents remains the first choice in most cases. Well-designed studies are needed to identify which patients will benefit most from closure.
Mirza
M
Jusufovic
Lars
L
Thomassen
Mona
M
Skjelland
D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D003287:Contrast Media; D017548:Echocardiography, Transesophageal; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012965:Sodium Chloride; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
D003287:Contrast Media; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D012965:Sodium Chloride