Abstract
Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke, arterial desaturation, decompression illness, and migraine headache (MH). This study evaluated the safety of percutaneous transcatheter PFO closure in patients with cryptogenic stroke, transient ischemic attack, or arterial desaturation. Additionally, symptomatic reduction in MH was determined after interatrial shunt closure. Of the 252 patients referred to the University of California, Los Angeles, with PFO, 131 underwent closure of the interatrial communication with a CardioSEAL (n = 30) or Amplatzer (n = 101) device. PFO morphology was evaluated with transesophageal echocardiography. Follow-up was conducted at 1 to 2 months with echocardiography, with clinical assessment annually thereafter. At an average follow-up of 30 months, there was no recurrence of any thromboembolic event (transient ischemic attack, stroke, or peripheral). There was a reduction in MH, defined as the complete resolution of headache or a >50% reduction in the number of headache days, in 85% of patients after PFO closure. Temporary problems after device implantation, including chest discomfort and palpitations, were reported in 23% of patients and occurred more frequently in patients with nickel hypersensitivity (p <0.05). In conclusion, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events and MH associated with interatrial shunting in patients who present with cryptogenic stroke. Pending randomized, controlled trials are necessary to determine if this invasive approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with MH.
Highlights
There are currently 2 randomized clinical trials evaluating whether the percutaneous closure of patent foramen ovale (PFO) can prevent the recurrence of cryptogenic stroke compared with anticoagulation or antiplatelet therapy
20 patients were reclassified from the transient ischemic attack (TIA) group to the migraine headache (MH) group on the basis of their clinical presentations, neurologic assessments, and magnetic resonance imaging (MRI) findings
There was a significant increase in the incidence of MH or palpitations (p ϭ 0.025) and MH or chest discomfort (p ϭ 0.05) in patients with nickel allergies. This retrospective analysis of 131 patients who underwent percutaneous closure with CardioSEAL or Amplatzer devices demonstrates the relative safety of percutaneous transcatheter PFO closure for patients who present with cryptogenic stroke
Summary
There are currently 2 randomized clinical trials evaluating whether the percutaneous closure of patent foramen ovale (PFO) can prevent the recurrence of cryptogenic stroke compared with anticoagulation or antiplatelet therapy. Patients with documented PFO and previous embolic events are at increased risk for recurrent stroke of up to 4.2% per year, even in the context of therapeutic anticoagulation.[1,2,3,4] Percutaneous transcatheter closure is a potential option for patients with PFO and thromboembolic phenomena that avoids the morbidity associated with surgical closure or lifelong anticoagulation.[1] long-term data on the effectiveness of transcatheter PFO closure in stroke prevention are limited. The present report details our 5-year experience with percutaneous transcatheter PFO closure for the prevention of recurrent stroke
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