Multidisciplinary approach to Patent Foramen Ovale (PFO) closure for Cryptogenic Stroke: Brain-Heart Board Experience (P11-5.024)

Abstract

<h3>Objective:</h3> Our study evaluates the predictors of closure recommendation by multidisciplinary board for PFO closure and its impact on outcomes. <h3>Background:</h3> PFO closure in carefully selected patients is an effective secondary preventive strategy in young cryptogenic stroke patients which requires close collaborative approach. <h3>Design/Methods:</h3> Brain-Heart Board is comprised of vascular neurology and cardiology subspecialities. Adult patients referred to the board for consideration of PFO closure between October 2017 to March 2021 were included in this analysis. Demographics, comorbid conditions, infarct location, Risk of Paradoxical Embolism (RoPE) Score, event frequencies (recurrent TIA or stroke, intracranial hemorrhage (ICH), post-PFO closure cardiac arrythmias) and modified Rankin Scale (mRS at 1 year) were compared between the groups (PFO closure vs. medical management). Multivariable logistic regression was used to identify predictors of closure and chi-square tests to test differences in outcomes for patients according to management. <h3>Results:</h3> 270 patients (229 stroke; 41 TIA) were included in the analysis. 119 (44%) patients were recommended for PFO closure of which 117 (98%) had infarct on neuroimaging. Age and RoPE score were similar in closure and medical management cohorts (age; 50±12 vs. 52±13, p&gt;0.05 RoPE 4±3 vs. 6±2 p&gt;0.05). In multivariable analysis, absence of infarct on neuroimaging was an independent predictor of medical management recommendation by the board (OR 0.05 95% CI 0.01–0.19 p&lt;0.05). Event frequency was low in both cohorts (5.9% vs. 4.8% p&gt;0.05) and were comprised primarily of cardiac arrhythmias (6 atrial fibrillation and 1 ICH in Closure group; 1 TIA and 1 recurrent stroke in medical management group). Excellent functional outcome (mRS 0–1) was similar in both cohorts (66% vs. 71% p&gt;0.05) at 1 year. <h3>Conclusions:</h3> Multidisciplinary approach towards PFO closure results in low frequency of complications (recurrent ischemic stroke, ICH and post-PFO closure cardiac arrythmias) and good outcomes. Infarct on neuroimaging predicts closure recommendation by the multidisciplinary board. <b>Disclosure:</b> The institution of Dr. Khan has received research support from NINDS. The institution of Dr. Khan has received research support from Genentech. The institution of Dr. Khan has received research support from Spectrum Health-MSU alliance. Dr. Khan has received research support from NIH. Dr. McCarthy has nothing to disclose. Dr. Haggerty has nothing to disclose. Dr. Min has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott . Dr. Min has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic . Dr. Miller has nothing to disclose. Dr. Tsai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Merhi has nothing to disclose. Dr. Berkompas has received personal compensation in the range of $10,000-$49,999 for serving as a Proctor and consultant with Medtronic. Dr. Wees has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Ahrar has nothing to disclose. Mrs. Evans has nothing to disclose. Dr. Dahu has nothing to disclose. Dr. Gauri has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic . Dr. Gauri has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Atricure . Mrs. Moelker has nothing to disclose. Dr. Chalfoun has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Chalfoun has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Atricure. Dr. Chalfoun has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Atricure.