Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(3):241-248 | DOI: 10.5507/bp.2021.036

Interventional prevention of paradoxical embolism as the gold standard: End of discussion?

Radomir Nykl, Jan Precek, Martin Sluka, Stepan Hudec, David Richter, Petr Heinc, Milos Taborsky
Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic

Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.

Keywords: paradoxical embolism, patent foramen ovale, interatrial septal aneurysm, catheterization PFO closure

Received: January 30, 2021; Revised: May 27, 2021; Accepted: June 3, 2021; Prepublished online: June 14, 2021; Published: September 20, 2021  Show citation

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Nykl, R., Precek, J., Sluka, M., Hudec, S., Richter, D., Heinc, P., & Taborsky, M. (2021). Interventional prevention of paradoxical embolism as the gold standard: End of discussion? Biomedical papers, 165(3), 241-248. doi: 10.5507/bp.2021.036
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