RECCURENT STROKE PREVENTION METHODS COMPARISON: PATENT FORAMEN OVALE CLOSURE OR MEDICAL THERAPY?

Аннотация

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Background. Recent studies have shown correlation between recurrent stroke occurrence and patent foramen ovale (PFO). Its occurrence causes paradoxical embolism following recurrent stroke as the most likely mechanism which consists of thrombus transfusion through PFO from right to left atria. Aim. To compare safety and efficiency of PFO closure and medical therapy alone for preventing recurrent stroke. Material and Methods. We had a look into the matter of NCBI PubMed, Elsevier, Scopus, Embase and the Cochrane Central Register of Control Trials databases. Results and Discussion. Common model of closure device consists of 2 discs connected by thin waist. There are 3 main complications in case of closure devices usage: thrombus formation on the side of device or in the left auricle; device subunit erosion which leads to abrasion at the roof of the atria or aorta and pericardial effusion; atria fibrillation which results in disturbances of heart cycle what leads to lack of ventricle blood supply and heart failure. Device closure results in a significant reduction in recurrent stroke (49%). Trivial medical treatment program contains usage of aspirin, low molecular weight heparin and warfarin. The most important complications in the subject of this method are bleedings, neuphrotoxicity and Reye syndrome. Reduction in recurrent stroke is 25%. Conclusions. Although per cent of recurrent stroke reduction with device closure of PFO is exponentially higher, there are a lot of severe complications which can damage patient’s health. The efficiency of PFO closure may be increased by anticoagulant therapy using, for example with clot deformation on the sides of the device.