Management of patent foramen ovale in embolic stroke of undetermined source patients: Malaysian experts' consensus.

Autor:	Albart SA; Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Pulau Pinang, Malaysia., Yusof Khan AHK; Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Neurology, Serdang, Selangor, Malaysia. ahanifkhan@upm.edu.my., Wan Zaidi WA; Hospital Canselor Tuanku Muhriz (HCTM), Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia., Muthuppalaniappan AM; Gleneagles Hospital Penang, George Town, Pulau Pinang, Malaysia., Kandavello G; Institut Jantung Negara, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia., Koh GT; Hospital Serdang, Paediatric Cardiology Unit, Kajang, Selangor, Malaysia., Leong MC; Institut Jantung Negara, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia., Liew HB; Hospital Queen Elizabeth II, Department of Cardiology, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia., Ong BH; Kedah Medical Centre, Alor Setar, Kedah, Malaysia., Viswanathan S; Hospital Kuala Lumpur, Department of Neurology, Ministry of Health Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia., Hoo FK; Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Neurology, Serdang, Selangor, Malaysia., Looi I; Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Pulau Pinang, Malaysia., Yap YG; Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia., Law WC; Hospital Umum Sarawak, Department of Medicine, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia.
Jazyk:	angličtina
Zdroj:	The Medical journal of Malaysia [Med J Malaysia] 2023 May; Vol. 78 (3), pp. 389-403.
Abstrakt:	Introduction: About 20 to 40% of ischaemic stroke causes are cryptogenic. Embolic stroke of undetermined source (ESUS) is a subtype of cryptogenic stroke which is diagnosed based on specific criteria. Even though patent foramen ovale (PFO) is linked with the risk of stroke, it is found in about 25% of the general population, so it might be an innocent bystander. The best way to treat ESUS patients with PFO is still up for discussion. Materials and Methods: Therefore, based on current evidence and expert opinion, Malaysian expert panels from various disciplines have gathered to discuss the management of ESUS patients with PFO. This consensus sought to educate Malaysian healthcare professionals to diagnose and manage PFO in ESUS patients based on local resources and facilities. Results: Based on consensus, the Malaysian expert recommended PFO closure for embolic stroke patients who were younger than 60, had high RoPE scores and did not require long-term anticoagulation. However, the decision should be made after other mechanisms of stroke have been ruled out via thorough investigation and multidisciplinary evaluation. The PFO screening should be made using readily available imaging modalities, ideally contrasttransthoracic echocardiogram (c-TTE) or contrasttranscranial Doppler (c-TCD). The contrast-transesophageal echocardiogram (c-TEE) should be used for the confirmation of PFO diagnosis. The experts advised closing PFO as early as possible because there is limited evidence for late closure. For the post-closure follow-up management, dual antiplatelet therapy (DAPT) for one to three months, followed by single antiplatelet therapy (APT) for six months, is advised. Nonetheless, with joint care from a cardiologist and a neurologist, the multidisciplinary team will decide on the continuation of therapy.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu