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Secondary stroke prevention: patent foramen ovale, aortic plaque, and carotid stenosis.

Meier B, Frank B, Wahl A, Diener HC - Eur. Heart J. (2012)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital Bern, 3010 Bern, Switzerland. bernhard.meier@insel.ch

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.

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Ideal projection and area (dotted line) of transseptal puncture after patent foramen ovale closure.
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EHR443F6: Ideal projection and area (dotted line) of transseptal puncture after patent foramen ovale closure.

Mentions: Complications consist mostly of arteriovenous fistulae at the groin and are device- and technique-related.41,51,54 The same holds true for residual shunts and thrombus formation.55 Erosion of the free atrial wall, device endocarditis, or need for surgical explantation are exceedingly rare. Long-term safety is of utmost importance for a preventive procedure against a low risk in natural history. Rarely, supraventricular arrhythmias can be induced or triggered by the device leading to need for anticoagulation or left atrial ablation. Transseptal puncture (for later left atrial interventions) is rather optically guided and not impeded after device implantation (Figure 6).Figure 6


Secondary stroke prevention: patent foramen ovale, aortic plaque, and carotid stenosis.

Meier B, Frank B, Wahl A, Diener HC - Eur. Heart J. (2012)

Ideal projection and area (dotted line) of transseptal puncture after patent foramen ovale closure.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3303713&req=5

EHR443F6: Ideal projection and area (dotted line) of transseptal puncture after patent foramen ovale closure.
Mentions: Complications consist mostly of arteriovenous fistulae at the groin and are device- and technique-related.41,51,54 The same holds true for residual shunts and thrombus formation.55 Erosion of the free atrial wall, device endocarditis, or need for surgical explantation are exceedingly rare. Long-term safety is of utmost importance for a preventive procedure against a low risk in natural history. Rarely, supraventricular arrhythmias can be induced or triggered by the device leading to need for anticoagulation or left atrial ablation. Transseptal puncture (for later left atrial interventions) is rather optically guided and not impeded after device implantation (Figure 6).Figure 6

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital Bern, 3010 Bern, Switzerland. bernhard.meier@insel.ch

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.

Show MeSH
Related in: MedlinePlus