Randomized Clinical Trial Comparing the Efficacy of Percutaneous Closure of Patent Foramen Ovale (PFO) With Medical Treatment in Patients With Cryptogenic Embolism
试验速览
- 阶段
- 4 期
- 发起方
- 入组人数
- 414
- 试验地点
- 6
- 主要终点
- Time to death (Fatal stroke, cardiovascular, non-CV),
研究概览
简要总结
The purpose of this study is to compare two treatments strategies to prevent further attacks in patients who have suffered an stroke or occlusion of a major artery with no obvious reason other than a persistent small opening between the upper heart chambers
详细描述
In patients who have suffered a stroke or occlusion of a large artery in another body part of unknown origin a possible cause is a small opening between the upper heart chambers (patent foramen ovale, it is called). After birth this opening closes in 75% of the population, while it persists in 25% of people. It may allow a small blood clot to pass from the veins of the legs through the heart into the brain or other parts of the body. In order to reduce the risk for a further attack we have today more therapeutic options to choose from but it is unclear which strategy have the best outcome. This study is created to compare the effect of two treatment strategies:
- Medical treatment The purpose of medical treatment is to dilute the blood to a degree, that no thrombus formation occurs. Since the opening in the heart persists, treatment is usually recommended lifelong. And patients treated with coumadin must undergo regular blood tests to ensure an adequate effect of the drug.
- Catheter closure of patent foramen ovale An alternative method developed to close the small opening in the heart utilizes catheters which are introduced in a blood vessel in the groin and from there advanced to the heart. An umbrella device is then delivered through the catheter, positioned within the small defect and released. The umbrella is overgrown with own tissue within weeks to months and closes the small defect for ever.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age below 60 years
- •Ischemic stroke or peripheral thromboembolism, radiologically verified
- •Absence of an identifiable cause of embolism
- •Echocardiographically verified patent foramen ovale
- •Sufficient recovery from index event to allow independent daily activities
排除标准
- •Any identifiable cause for thromboembolic event other than PFO
- •Cardiac diseases: mural thrombus, dilated cardiomyopathy, prosthetic heart valve or mitral stenosis, endocarditis, atrial fibrillation
- •Vascular system: significant atherosclerosis or dissection of the aorta, collagen vascular disease, arteritis, vasculitis
- •Pre-existing neurologic disorders or intracranial disease, e.g., multiple sclerosis, arteriovenous malformations, previous hemorrhage
- •Contraindications for antithrombotic or anticoagulant therapy
- •Patients already on chronic anticoagulant therapy for another disease
- •Previous surgical or percutaneous PFO-closure
- •Drug or alcohol abuse
- •Pregnancy
- •Septicemia or severe infectious disease
- •Severe CNS disease
- •No informed consent
- •Foreseen difficulties with study compliance, especially the long-term follow-up
研究组 & 干预措施
Medical antitrhombotic treatment
干预措施: Medical antitrhombotic treatment (Drug)
Device Implant
Percutaneous closure of patent foramen ovale
干预措施: Percutaneous closure of patent foramen ovale (Device)
结局指标
主要结局
Time to death (Fatal stroke, cardiovascular, non-CV),
时间窗: continuosly
non-fatal cerebrovascular event,
时间窗: continuosly
peripheral embolism
时间窗: continuosly
次要结局
- New arrhythmias,(continuosly)
- myocardial infarction(continuosly)
- rehospitalization related to PFO or its treatment(continuosly)
- device problems(continuosly)
- bleeding complications(continuosly)