Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale–Associated Stroke

So is this now the protocol for PFOs? And where is it located so stroke patients can find it and deliver it to their doctors? 

Did your hospital put this protocol in place two years ago? Do you prefer your hospital incompetence NOT KNOWING OR NOT DOING? Ask your board of directors that question and don't leave until they answer.

Trial Bolsters Evidence in Favor of Closing Hole in Heart After Stroke March 2018

Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale–Associated Stroke

Akram Y. Elgendy, MD¹; Jeffrey L. Saver, MD²; Zahid Amin, MD³; et al Konstantinos Dean Boudoulas, MD⁴; John D. Carroll, MD⁵; Islam Y. Elgendy, MD⁶; Iris Q. Grunwald, MD^7,8; Zachary M. Gertz, MD⁹; Ziyad M. Hijazi, MD, MPH¹⁰; Eric M. Horlick, MD¹¹; Scott E. Kasner, MD¹²; David M. Kent, MD¹³; Preetham Kumar, MD¹⁴; Clifford J. Kavinsky, MD, PhD¹⁵; David S. Liebeskind, MD²; Helmi Lutsep, MD¹⁶; Mohammad K. Mojadidi, MD⁹; Steven R. Messé, MD¹²; Jean-Louis Mas, MD¹⁷; Heinrich P. Mattle, MD¹⁸; Bernhard Meier, MD¹⁹; Ahmad Mahmoud, MD, MSc²⁰; Ahmed N. Mahmoud, MD²¹; Fabian Nietlispach, MD, PhD²²; Nimesh K. Patel, MD⁹; John F. Rhodes, MD²³; Mark Reisman, MD²¹; Robert J. Sommer, MD²⁴; Horst Sievert, MD^7,8; Lars Søndergaard, MD²⁵; Muhammad O. Zaman, MD²⁰; David Thaler, MD¹³; Jonathan M. Tobis, MD; MSCAI14

Author Affiliations

JAMA Neurol. Published online April 13, 2020. doi:10.1001/jamaneurol.2020.0458

Abstract

Importance  Recent epidemiologic and therapeutic advances have transformed understanding of the role of and therapeutic approach to patent foramen ovale (PFO) in ischemic stroke. Patent foramen ovale is likely responsible for approximately 5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults.
Observations  Randomized clinical trials have demonstrated that, to prevent recurrent ischemic stroke in patients with PFO and an otherwise-cryptogenic index ischemic stroke, PFO closure is superior to antiplatelet medical therapy alone; these trials have provided some evidence that, among medical therapy options, anticoagulants may be more effective than antiplatelet agents.
Conclusions and Relevance  These new data indicate a need to update classification schemes of causative mechanisms in stroke, developed in an era in which an association between PFO and stroke was viewed as uncertain. We propose a revised general nomenclature and classification framework for PFO-associated stroke and detailed revisions for the 3 major stroke subtyping algorithms in wide use.

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