We're going to finish talking about Pate Informant Ovali after Cryptogenic Stroke,

and this is the second part.

And I would suggest listening to the first part if you don't feel real comfortable with the topic of

patent form in Ovali because some important points were made that will be built upon this time around.

And so this lecture is going to focus much more on these trials that just recently came

out in the September 14, 2017 New England Journal of Medicine.

And there are some things that bind all three of these trials together. Yes, one thing that binds

them is they showed benefit to closing the paid informantle valley. How much benefit? Well, we'll get

into that. But one of the things that binds them is they were looking at young patients. So no patient, not one, in any of the three trials,

had a patient older than the age of 60. Now, there is a pretty good reason why they did that.

And the thing is, we have to remember that we probably only want

to close a patent form in O Valley if we feel real comfortable that there is not another

etiology for the so-called cryptogenic stroke. As we get older, we start developing a lot more risk factors for stroke,

and that includes worsening athloskerosis, right?

So if you have a patent form in ovale, but you also have 30% carotid athloscarosis, even though that wouldn't be

enough for us to consider carotid nendar-drectomy. Are you sure you didn't break off a little bit of

that athalaccharosis to cause the clot? And it wasn't the patent forminal vali. So you get the idea

that usually we are most worried about

patent forminal valley in younger patients that don't have any other explanation

for why they may have had this stroke.

In this point is really tough to over-emphasize because I see this all time and I work with my

residents that I work with on this issue frequently, which is over-calling the ideology of

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