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Lenox Hill Hospital Research to Help Determine Most Effective Stroke Prevention Method for Young Stroke Survivors

April 1, 2004

Although strokes can occur at any age, it's surprising when they happen to people in their 20s, 30s or even 40s. Lenox Hill Hospital is partnering with the National Stroke Association (NSA) to urge young stroke survivors to ask their doctors about patent foramen ovale (PFO), a congenital hole in the heart that often has no symptoms, but can increase recurrent stroke risk in some patients.

Doctors do not have a definitive answer as to the most effective way to reduce the risk of recurrent strokes in patients with PFO. Now, stroke survivors and TIA (mini-stroke) survivors with PFOs can participate in a national FDA approved research study underway at Lenox Hill Hospital to help provide that answer.

Everyone is born with an opening between the right and left atria, or upper chambers, of the heart. In most cases, this opening seals itself shortly after birth. In about one in five Americans, the opening doesn't seal and can open when the chest is strained, such as during coughing or sneezing. The PFO can enable blood clots to travel from one area of the body (such as a leg vein) through the heart and up to the brain, possibly causing a stroke.

A PFO also can play a role in transient ischemic attacks (TIAs). Known as mini-strokes, TIAs are brief episodes of stroke symptoms that come and go quickly. Unlike strokes, TIAs do not cause brain damage. Most PFO-related strokes and TIAs are cryptogenic, meaning they have no apparent cause until the PFO is diagnosed.

Currently there are two primary treatment options for PFO: medications and PFO closure, a minimally invasive closure-implant procedure. Open-heart surgery is also an option, but is rarely used due to the invasive nature of the surgery and the risks involved. Blood-thinning medications can be prescribed to influence clotting properties of the blood. The theory is that if the blood forms fewer clots, there is less risk of a clot making its way through the PFO to the brain and causing a stroke.

With the PFO-closure implant, a device is placed in the heart to seal the flap. Blood clots cannot pass through and travel to the brain. It is not known, however, which of these treatments is most effective for stroke prevention.

Lenox Hill Hospital is now conducting a research study comparing blood-thinning medications with the PFO-closure implant procedure. NSA encourages young stroke survivors with PFOs to consider all options, including participating in this research. They can benefit from careful evaluation by doctors and receive extensive follow-up care.

"It is clear that a relationship exists between a 'hole' in the heart called a Patent Foramen Ovale (PFO), and strokes in young patients with no other risk factors. When a physician identifies a PFO in a young patient with a stroke or a TIA, the next step is unclear. Today, we simply do not know whether closing the PFO (non-surgical) or remaining on blood thinners is the most effective way to prevent additional strokes in these patients. The CLOSURE I study will determine the better form of therapy," said Robert Sommer, M.D., Director of Adult Congenital Heart Disease, Lenox Hill Hospital and an Investigator of CLOSURE I.

For more information on this trial you may contact The NSA by calling 1-800-STROKES (1-800-787-6537) or visit www.stroke.org.

Members of the press seeking information about Lenox Hill Hospital should call the Public Relations Department at (212) 434-2400.