Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long‐term follow‐up of 301 cases

Abstract

Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 6 11.0 years, 54.4% male, with !1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Followup duration was 40.2 6 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n 5 1; road traffic accident n 5 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke. V C 2015 Wiley Periodicals, Inc.

Patent foramen ovale (PFO) closure versus medical therapy for prevention of recurrent stroke in patients with prior cryptogenic stroke: A systematic review and meta‐analysis of randomized controlled trials

“…This has allowed the demonstration of a significant benefit for patients treated with PFO closure with regard to reduction in risk of stroke. Our results are consistent with the findings of the two most recent trials and with the results of recent observational studies that reported that PFO closure was associated with a lower risk of stroke.…”

Angiography vs transesophageal echocardiography‐guided patent foramen ovale closure: A propensity score matched analysis of a two‐center registry

“…The procedure has acceptably low risks both in the short term, with 2.1% rate of procedural complications all resolved in a few days, and in the long term, with 7.5% rate of events after more than 3 years of medium follow‐up. In particular, recurrent cerebral ischemia is 1.9%, which is consistent with the available literature, reporting occurrence of embolic events ranging from 2.1% during a mean follow‐up of 2.6 years, to 1.6% with a mean follow‐up duration of 40 ± 26 months, to a 0.28% annual/patient risk beyond 5 years’ follow‐up; those data consolidate the role of PFO closure as a secondary prevention after PFO‐related stroke. Atherosclerotic vascular disease progression or silent atrial fibrillation may have played a role in the ischemic recurrences in both groups.…”

Long‐Term Contrast Echocardiography and Clinical Follow‐Up after Percutaneous Closure of Patent Foramen Ovale Using Two Different Atrial Septal Occluder Devices

“…In a study by Mirzaali et al, 301 patients underwent percutaneous PFO closure with 1 of 8 devices, with successful implantation in 99% of cases. Follow‐up duration was 40.2 ± 26.2 months, recurrent stroke (MRI‐ or CT‐confirmed) was observed in 5 patients (0.5%; 0.55 per 100 person‐years) and TIA in 9 (1.1%; 0.98 per 100 person‐years) . In a study by Bardeleben et al, concerning a cumulative follow‐up period of 1265 patient‐years, the recurrence/re‐event rate of cerebral and peripheral thromboembolic events was 0.7% per patient‐year.…”