SynthesisEuropean heart journal2018
Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials.
Synthesis in European heart journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06504121 (PFO tRanscatether Occlusion Long-term Outcomes National Group), which is not on this map. Cited by 56 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
PFO tRanscatether Occlusion Long-term Outcomes National Group (PROLONG) Registry
Who cites it
56 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials.European heart journal · 2020Pooled it
- Complete Revascularization by Percutaneous Coronary Intervention for Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease: An Updated Meta-Analysis of Randomized Trials.Journal of the American Heart Association · 2020Pooled it
- Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis.Internal and emergency medicine · 2018Pooled it
- Patent foramen ovale closure versus medical therapy for prevention of recurrent cryptogenic embolism: updated meta-analysis of randomized clinical trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2018Pooled it
- Updated Meta-analysis on the Closure of Patent Foramen Ovale in Reduction of Stroke Rates: the DEFENSE-PFO Trial Does not Change the Scenario.Brazilian journal of cardiovascular surgeryPooled it
- Trial
- Pediatric Stroke Due to Thromboembolism Secondary to Prominent Eustachian Valve With Patent Foramen Ovale.JACC. Case reports · 2026Article
- Middle cerebral artery occlusion due to paradoxical embolism diagnosed by pulmonary artery thrombosis in the absence of deep vein thrombosis: A case report.Radiology case reports · 2026Article
- Bioresorbable patent foramen ovale closure-is less more?Cardiovascular diagnosis and therapy · 2026Article
- Agitated Saline Contrast Echocardiography in the diagnosis of right to left shunts: Guidance and recommendations from the British Society of Echocardiography.Echo research and practice · 2026Review
- Diagnosis and Management of Patent Foramen Ovale for Stroke Prevention: An Australian and New Zealand Consensus Statement Developed by a Modified Nominal Group Approach.The Medical journal of Australia · 2026Article
- Impact of Patent Foramen Ovale Anatomical Complexity on Fluoroscopy Time During Transcatheter Closure.Acta Cardiologica Sinica · 2026Article
- Stroke and transient ischemic attack recurrence after PFO closure in patients with cryptogenic embolism.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
- Incremental value of characteristics of right-to-left shunt in patients with migraine and cryptogenic stroke via multi-modal echocardiography.Quantitative imaging in medicine and surgery · 2026Article
- Review
- Paradoxical Thalamic Infarction via Patent Foramen Ovale in an Athletic Young Adult: A Case Report.Cureus · 2025Article
- Article
- Stroke recurrence after transcatheter PFO closure in patients with cryptogenic stroke.International journal of stroke : official journal of the International Stroke Society · 2025Article
- Comparative Effectiveness of Devices for Interventional Patent Foramen Ovale Closure: Insights from a 23-Year Monocentric Analysis.Journal of clinical medicine · 2024Article
- Influence of procedural timing on the preventive yield of percutaneous patent foramen ovale closure.Open heart · 2024Article
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
Aims: The efficacy of patent foramen ovale (PFO) closure for cryptogenic stroke has been controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) comparing device closure with medical therapy to prevent recurrent stroke for patients with PFO. Methods and results: We systematically identified all RCTs comparing device closure to medical therapy for cryptogenic stroke in patients with PFO. The primary efficacy endpoint was recurrent stroke, analysed on an intention-to-treat basis. The primary safety endpoint was new onset atrial fibrillation (AF). Five studies (3440 patients) were included. In all, 1829 patients were randomized to device closure and 1611 to medical therapy. Across all patients, PFO closure was superior to medical therapy for prevention of stroke [hazard ratio (HR) 0.32, 95% confidence interval (95% CI) 0.13-0.82; P = 0.018, I2 = 73.4%]. The risk of AF was significantly increased with device closure [risk ratio (RR) 4.68, 95% CI 2.19-10.00, P<0.001, heterogeneity I2 = 27.5%)]. In patients with large shunts, PFO closure was associated with a significant reduction in stroke (HR 0.33, 95% CI 0.16-0.72; P = 0.005), whilst there was no significant reduction in stroke in patients with a small shunt (HR 0.90, 95% CI 0.50-1.60; P = 0.712). There was no effect from the presence or absence of an atrial septal aneurysm on outcomes (P = 0.994). Conclusion: In selected patients with cryptogenic stroke, PFO closure is superior to medical therapy for the prevention of further stroke: this is particularly true for patients with moderate-to-large shunts. Guidelines should be updated to reflect this.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.