Recurrent cerebral ischemia after patent foramen ovale percutaneous closure in older patients: A two‐center registry study

Scacciatella, Paolo; Meynet, Ilaria; Presbitero, Patrizia; Giorgi, Mauro; Lucarelli, Carla; Parenti, Dennis Zavalloni; Biava, Lorenza; Marra, Sebastiano

doi:10.1002/ccd.26053

Cited by 26 publications

(22 citation statements)

References 21 publications

(20 reference statements)

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“…These findings should thus be interpreted carefully because patients were relatively younger and the follow-up period was short. Other studies with older patients showed less benefit of percutaneous PFO closure compared to younger patients [4, 5]. However, these studies evaluated all causes of stroke recurrence, not only PFO-related cerebrovascular events.…”

Section: Discussionmentioning

confidence: 99%

“…However, most studies did not include elderly patients (age ≥ 60 years), and little is known about the clinical benefit of percutaneous PFO closure in older patients. In addition, previous studies have shown that recurrent cerebral ischemia after PFO closure was higher in older than in younger patients [4, 5]. However, PFO-related recurrent cerebral ischemia was not sufficiently evaluated in these studies.…”

Section: Introductionmentioning

confidence: 96%

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Percutaneous transcatheter closure of high-risk patent foramen ovale in the elderly

et al. 2019

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The efficacy of percutaneous transcatheter closure for preventing recurrent cerebrovascular events in elderly patients with high-risk patent foramen ovale (PFO) remains unclear, whereas in young patients, it has been shown to effectively prevent the recurrence of embolic stroke. The aim of this study was to investigate the safety and efficacy of percutaneous PFO closure in elderly patients with high-risk PFO. Between September 2012 and October 2018, 14 patients ≥ 60 years old with high-risk PFO underwent percutaneous closure to prevent recurrence of cerebrovascular events. The primary end point was recurrence of cerebrovascular events after closure in elderly patients with high-risk PFO, and the secondary end points were occurrence of device-related complications, cerebral hemorrhage, and new-onset atrial fibrillation (AF). The mean patient age and number of cerebrovascular events before closure were 75.2 ± 6.5 years and 1.7 ± 0.7, respectively. All procedures were successfully performed under general anesthesia by transesophageal echocardiography and using a 25-mm Amplatzer Cribriform device. No procedure-related complications occurred. Patients were followed up for a mean 2.6 ± 1.8 years. No patients experienced device-related complications or recurrent cerebrovascular events. However, one patient had AF-related device closure complications at 1 month postoperatively. In addition, other patient had a cerebral hemorrhage with unknown relationship to PFO closure 3 years postoperatively. Percutaneous closure of high-risk PFO in elderly patients may be as effective and safe as in younger patients. It is crucial to evaluate PFO morphology regardless of age in cases of paradoxical embolism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Percutaneous transcatheter closure of high-risk patent foramen ovale in the elderly

et al. 2019

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“…Most of studies about PFO closure included young patients (<55 years old). A recent study, compared the outcomes of PFO closure between a young (<55 years old) and an old group (>55 years old) of patients 20 . It was found that in older patients, PFO closure was as safe as in younger patients, but recurrent cerebral ischemia was more frequent and likely this is associated to conditions related to age than to paradoxical embolism 20 .…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale closure versus medical therapy for stroke prevention: A systematic review and meta-analysis of randomized controlled trials

Lai

Tse

et al. 2018

F1000Res

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Background: Previous randomized trials on patent foramen ovale (PFO) closure versus medical therapy for stroke prevention were inconclusive. Recently, two new randomized trials and new findings from an extended follow-up of a previous trial have been published on this topic. We conducted a systematic review and meta-analysis of randomized trials comparing PFO closure with medical therapy for stroke prevention. Methods: PubMed and Cochrane Library were searched until 16 th September 2017. The following search terms were used for PubMed: "patent foramen ovale" AND (stroke OR embolism) and "randomized" AND "Trial". For Cochrane Library, the following terms were used: "patent foramen ovale" AND "closure" AND (stroke OR embolism). Results: A total of 91 and 55 entries were retrieved from each database using our search strategy respectively, of which six studies on five trials met the inclusion criteria. This meta-analysis included 1829 patients in the PFO closure arm (mean age: 45.3 years; 54% male) and 1972 patients in the medical therapy arm (mean age: 45.1 years; 51% male). The median follow-up duration was 50 ± 30 months. When compared to medical therapy, PFO closure significantly reduced primary endpoint events with a risk ratio [RR] of 0.60 (95% CI: 0.44-0.83, P < 0.0001; I 2: 15%). It also reduced stroke (RR: 0.50, 95% CI: 0.35-0.73, P < 0.0001; I 2: 32%) despite increasing the risk of atrial fibrillation/flutter (RR: 1.90, 95% CI: 1.23-2.93, P < 0.01; I 2: 43%). However, it did not reduce transient ischemic accident events (0.75; 95% CI: 0.51-1.10, P = 0.14; I 2: 0%), all-cause bleeding (RR: 0.89; 95% CI: 0.44-1.78, P = 0.74; I 2: 51%) or gastrointestinal complications (RR: 0.92; 95% CI: 0.32-2.70, P = 0.88; I 2: 0%). Conclusions: PFO closure significantly reduces risk of stroke when compared to medical treatment and should therefore be considered for stroke prevention in PFO patients.

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“…The panel found 8 studies (2 RCT, 6 observational) that reported on antithrombotic regimens including duration and outcomes (Table 3). Four other studies (3 observational [52][53][54] and 1 RCT 12 ) reported a regimen of 3 months of dual antiplatelet therapy (DAPT) followed by aspirin monotherapy. These studies reported associated stroke rates of 0, 4.3, 1, and 0 per 1000 patient-years, respectively.…”

Section: Recommendationmentioning

confidence: 99%

SCAI Guidelines for the Management of Patent Foramen Ovale

Kavinsky

Goldsweig

Amin

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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Recurrent cerebral ischemia after patent foramen ovale percutaneous closure in older patients: A two‐center registry study

Abstract: Recurrent cerebral ischemia after PFO closure is more frequent in older patients and could most likely be associated to conditions related to age (atherosclerosis, atrial fibrillation), than to paradoxical embolism. The procedure is as safe as in younger patients.

Cited by 26 publications

References 21 publications

Percutaneous transcatheter closure of high-risk patent foramen ovale in the elderly

Percutaneous transcatheter closure of high-risk patent foramen ovale in the elderly

Patent foramen ovale closure versus medical therapy for stroke prevention: A systematic review and meta-analysis of randomized controlled trials

SCAI Guidelines for the Management of Patent Foramen Ovale

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