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Published on: February 26, 2013
Transcatheter closure of patent foramen ovale after presumed paradoxical embolism
N D Bridges1, W Hellenbrand, L Latson
1Department of Cardiology, Harvard Medical School, Boston, MA.
Insights
Transcatheter closure of patent foramen ovale (PFO) is safe and may reduce stroke recurrence in patients with cryptogenic stroke. Further research is needed to identify at-risk populations and confirm intervention effectiveness.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- A patent foramen ovale (PFO) is often linked to cryptogenic stroke.
- The efficacy of PFO closure in preventing recurrent strokes remains unclear.
Purpose of the Study:
- To evaluate the safety and potential efficacy of transcatheter PFO closure in patients experiencing paradoxical emboli.
Main Methods:
- Transcatheter closure of PFO using a double-umbrella device was performed in 36 patients with a history of stroke or transient neurological events attributed to right-to-left shunting.
- Patients had a mean of 1.8 events each, with many having no other identified stroke risk factors.
- The procedure was technically successful in all patients without serious complications.
Main Results:
- No strokes occurred during a mean follow-up of 8.4 months.
- Device closure resulted in complete closure in 28 patients, with minor residual shunting in others.
- The procedure demonstrated low morbidity.
Conclusions:
- Transcatheter PFO closure is a feasible and safe procedure.
- PFO closure may offer a reduced risk of recurrent stroke, warranting further investigation.
- Identifying specific patient populations who benefit most from PFO closure is crucial.
Background:
Many have proposed a relation between presence of a patent foramen ovale, with or without atrial septal aneurysm, and cryptogenic stroke. The effect of foramen ovale closure on the risk for subsequent strokes is unknown.
Methods And Results:
Transcatheter closure of a patent foramen ovale was undertaken in 36 patients with known right-to-left atrial shunting and presumed paradoxical emboli (31 strokes, 25 transient neurological events, four systemic arterial emboli, and two brain abscesses). Individual patients had between one and four such events. None had a left heart or carotid source of embolism; 31 of 35 had no known risk factors for stroke. Events occurred in 12 patients while they were taking warfarin. At cardiac catheterization, patent foramina ovalia were significantly larger than predicted for age in 67% of the patients. Implantation of a double-umbrella device in the patent foramen ovale was achieved in all without serious procedural complications. Of 34 who have returned for follow-up, one has a residual atrial communication that may be clinically important, five had trivial leaks, and 28 have complete closure. There have been no strokes during a mean follow-up of 8.4 months.
Conclusions:
Transcatheter closure of a patent foramen ovale can be accomplished with little morbidity and may reduce the risk of recurrence. Further investigations directed toward identifying the population at risk and assessing the effect of intervention are warranted.
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