Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale...

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Patent Foramen Ovale (PFO) is a potential cause of stroke.
• The PFO-Associated Stroke Causal Likelihood classification system uses patient and PFO features to predict treatment response.
• The specific impact of PFO shunt size and atrial septal aneurysm (ASA) on stroke recurrence after PFO closure needs further clarification.

Purpose of the Study:

• To investigate the association between Patent Foramen Ovale (PFO) closure and recurrent ischemic stroke.
• To evaluate how PFO shunt size and the presence of an atrial septal aneurysm (ASA) modify the effectiveness of PFO closure in preventing stroke recurrence.

Main Methods:

• Pooled individual patient data from 6 randomized clinical trials comparing PFO closure with medical therapy.
• Analysis included 3740 patients with PFO-associated stroke, stratified by PFO shunt size (small vs. large) and presence/absence of ASA.
• Recurrent ischemic stroke was the primary outcome, assessed over a median follow-up of 57 months.

Main Results:

• PFO closure significantly reduced the risk of recurrent ischemic stroke (aHR, 0.41).
• The benefit of PFO closure was significantly greater in patients with both a large shunt and an ASA (aHR, 0.15) compared to other subgroups.
• Patients with large shunt and ASA experienced a greater absolute risk reduction in recurrent stroke at 2 years (5.5%) compared to other categories (1.0%).

Conclusions:

• PFO closure is effective in reducing recurrent stroke, particularly in patients with specific PFO characteristics.
• A combination of large shunt size and the presence of an ASA identifies patients who derive the most substantial benefit from PFO closure.
• These findings can aid in shared decision-making between patients and clinicians regarding PFO closure treatment.