Begin forwarded message:
From: Scott Kasner <kasner@mail.med.upenn.edu>
Date: November 16, 2010 2:01:12 PM EST
To: BB <261penn@gmail.com>
Subject: pfo
Dear Beau,
The results of the first randomized PFO closure trial were finally detailed yesterday. Overall, there was no benefit for PFO closure vs medical therapy, with an annual stroke rate of 1.5%. Coumadin was not better than aspirin as medical therapy either. One interpretation of this study is that PFOs should not be closed and aspirin alone is enough. I am certain that insurers will interpret it that way and will very soon stop covering this procedure for anyone.
However, there were some issues with the study design that may make it not fully applicable to your situation. Some notable points:
1. They included patients who clearly had other explanations for their strokes (aortic arch atherosclerosis, small arterial disease, others). These patients have a high risk of recurrent stroke and PFO closure will not impact those other causes.
2. They included patients who had TIAs with negative MRIs, and those patients are extremely unlikely to have a future stroke with or without PFO closure.
3. Among the patients who had device closure, about 25-30% of the strokes were related to the procedure, while newer devices are less likely to cause clotting or local injury because of their enhanced designs.
Many stroke specialists including myself think that there are many good reasons to continue ongoing research in this area, including the trial that we discussed, to determine whether PFO closure is useful in patients who truly have no other explanation for their stroke. Outside of trials, there is no reason to perform PFO closure or use anything other than aspirin.
E-mail or call me at 215 662 3564 to discuss at length, or let me know if you want to come in for a face-to-face visit.
Ultimately I want to make sure that you are comfortable with whatever decision you make, and now we have more information that may help to guide that decision.
Best regards,
Dr Kasner
Scott Eric Kasner, MD, MSCE, FAHA
Professor of Neurology
Director, Comprehensive Stroke Center
University of Pennsylvania Medical Center
3 West Gates Building
3400 Spruce Street
Philadelphia, PA 19104
Phone:(215) 662-3564
Fax: (215) 614-1927
kasner@mail.med.upenn.edu
"Hearts and kidneys are tinkertoys!
I am talking about the central nervous system!"
- Dr. Frederick Frankenstein
(neurosurgeon and grandson of Dr. Victor Frankenstein
in Mel Brooks' Young Frankenstein)
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