Neuer Stellenwert des PFO-Verschlusses in der klinischen Praxis

Zusammenfassung

Was tun bei Patienten mit kryptogenem Schlaganfall und persistierendem Foramen Ovale (PFO)? Nach bisheriger Datenlagen wurden durch die neurologischen und kardiologischen Leitlinien in aller Regel eine sekundärprophylaktische Therapie mit einem Thrombozytenfunktionshemmer empfohlen. Drei im September 2017 im New England Journal of Medicine publizierte Studien (CLOSE, REDUCE, RESPECT-Langzeitdaten) verändern die Datenlage: hiernach ist der PFO-Verschluss gegenüber einer rein medikamentösen thrombozytenfunktionshemmenden Therapie sekundärprophylaktisch besser wirksam, allerdings nur bei ausgewählten Patienten. In diesem Beitrag werden die neuen Studien und ihre Wertigkeit inklusive zahlreicher offener Fragen kritisch besprochen.

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