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Patent foramen ovale closure and brain ischaemic lesions: the response
  1. Pascal Meier1,2,
  2. Mathias Wolfrum3,
  3. Georg M Froehlich1,
  4. Leanne K Casaubon,
  5. Alexandra J Lansky2
  1. 1Yale—UCL Cardiovascular Research Program, The Heart Hospital, University College London Hospitals UCLH, London, UK
  2. 2Division of Cardiology, Yale Medical School, New Haven, Connecticut, USA
  3. 3Division of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
  4. 4Division of Neurology, Stroke Program, Toronto Western Hospital, Toronto, Canada
  1. Correspondence to Dr Pascal Meier, Yale—UCL Cardiovascular Research Program, The Heart Hospital, University College London Hospitals, UCLH16-18 Westmoreland Street, London W1G 8PH, UK; pascalmeier74{at}

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We thank Dr Ammirati and his colleagues for their very valuable comments on our paper.1 We agree with their interpretation, the low incidence of non-fatal strokes in the medical arm (<1% per annum) makes it very difficult to demonstrate a significant reduction in events with any intervention. This is even more the case for invasive interventions which are of course associated with a periprocedural complication risk. The longer term …

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