Transcatheter closure versus antithrombotic therapy for cryptogenic stroke in elderly patients with patent foramen ovale: a systematic review and meta-analysis of non-randomized studies

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI:10.1016/j.jstrokecerebrovasdis.2026.108562

Yang Dong MD , Cong Lu MD , Tiantian Luo PhD , Hao Huang MD , Yan Xiong MD , Jie Zeng MD

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Abstract

Background

There is lacking of robust clinical evidence comparing transcatheter closure with antithrombotic therapy in elderly patent foramen ovale (PFO) patients with cryptogenic stroke.

Methods

The Pubmed, Embase, Web of Science, clinicaltrials.gov and Cochrane Library databases were systematically searched. Studies comparing transcatheter closure therapy with antithrombotic drug therapy in PFO patients in older age (≥55 years old) were included. The number of patients with and without events in both experimental group and control group were extracted. There were three study endpoints: composite endpoint of recurrent ischemic stroke and transient ischemic attack (TIA); all-cause death; new-onset atrial fibrillation. A random-effect model was performed. Heterogeneity among selected publications was assessed using Q-test based on a χ² test. I²>50% was defined as high heterogeneity. P < 0.05 was considered statistically significant.

Results

Nine studies of 7275 elderly PFO patients with cryptogenic stroke were included. Patients undergoing PFO closure had significantly lower risk of a composite endpoint of recurrent stroke and TIA (4.74% versus 8.08%, OR=0.517, 95% CI:0.325-0.821) and all-cause death (1.17% versus 1.24%, OR=0.531, 95% CI: 0.317-0.891). There was no significant different occurrence of new-onset atrial fibrillation between the two groups (3.81% versus 2.82%, OR=1.218, 95% CI: 0.826-1.798). None of the studies measuring the three endpoints manifested high heterogeneity.

Conclusions

PFO closure might reduce the risk of composite endpoint of recurrent stroke and TIA and all-cause death, while not increase the risk of new-onset atrial fibrillation comparing with medication therapy in elderly PFO patients with cryptogenic stroke. PFO closure should be considered part of a comprehensive secondary prevention strategy in elderly patients.

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经导管闭合与抗血栓治疗治疗老年卵圆孔未闭患者隐源性卒中：一项非随机研究的系统回顾和荟萃分析

背景：对于老年隐源性脑卒中卵圆孔未闭（PFO）患者，比较经导管闭合与抗血栓治疗缺乏强有力的临床证据。方法：系统检索Pubmed、Embase、Web of Science、clinicaltrials.gov和Cochrane Library数据库。比较高龄PFO患者（≥55岁）经导管闭合治疗与抗血栓药物治疗的研究。提取实验组和对照组发生和未发生事件的患者数量。研究有三个终点：复发性脑卒中和短暂性脑缺血发作（TIA）的复合终点；全因死亡;新发心房颤动。采用随机效应模型。采用基于χ 2检验的q检验评估所选出版物的异质性。I2>50%定义为高异质性。P < 0.05为差异有统计学意义。结果：9项研究纳入7275例老年PFO伴隐源性卒中患者。接受PFO闭合的患者卒中和TIA复发的复合终点（4.74%对8.08%，OR=0.517, 95% CI: 0.25 -0.821）和全因死亡（1.17%对1.24%，OR=0.531, 95% CI: 0.317-0.891）的风险显著降低。两组间新发房颤发生率无显著差异（3.81% vs 2.82%， OR=1.218, 95% CI: 0.826-1.798）。测量这三个终点的研究均未显示出高度异质性。结论：与药物治疗相比，PFO关闭可降低老年PFO隐源性卒中合并TIA复合终点复发风险和全因死亡风险，但不会增加新发房颤的风险。PFO闭合应被视为老年患者综合二级预防策略的一部分。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.