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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Stroke recurrence and its prevention in patients with patent foramen ovale

J U Harrer1, T Wessels, A Franke

  • 1Department of Neurology, Aachen University Hospital, Aachen, Germany.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|April 6, 2006
PubMed

Insights

Medical or invasive treatments for stroke in patent foramen ovale (PFO) patients show low recurrence. Previous ischemic events and larger shunts are key risk factors for recurrent strokes.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Patent foramen ovale (PFO) is a suspected cause of cryptogenic stroke.
  • Optimal treatment strategies to prevent recurrent ischemic events remain unclear.
  • The role of concomitant risk factors in stroke recurrence requires further elucidation.

Purpose of the Study:

  • To compare the effectiveness of medical versus invasive (catheter or surgical) treatments for PFO-related stroke prevention.
  • To identify risk factors associated with recurrent ischemic events in patients with PFO.

Main Methods:

  • A prospective observational study followed 124 patients with cryptogenic cerebral ischemia and PFO for a mean of 52 months.
  • Patients were treated medically (n=83), with transcatheter closure (n=34), or surgical closure (n=7).
  • Recurrent ischemic events and associated risk factors were analyzed.

Main Results:

  • Annual stroke recurrence rates were low and comparable between medical and catheter-treated groups (2.9% vs. 2.1%).
  • Patients with recurrent strokes had significantly larger shunts (OR=5.0) and a history of previous ischemic events (OR=4.4).
  • Pulmonary embolism and case fatality rates were higher in patients experiencing stroke recurrence.

Conclusions:

  • The absolute risk of recurrent cerebrovascular events is low with medical or catheter interventional therapy for PFO.
  • Previous ischemic events and shunt size are significant risk factors for recurrence.
  • Randomized controlled trials are recommended to definitively establish optimal treatment strategies.
Abstract

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