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Published on: February 8, 2022
Transcatheter Patent Foramen Ovale Closure in Patients With Transient Ischemic Attack
Julio I Farjat-Pasos1, Paul Guedeney2, Christine Houde3
1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Insights
Patent foramen ovale (PFO) closure in patients experiencing transient ischemic attack (TIA) shows safe and effective outcomes. Long-term results for TIA patients undergoing PFO closure are comparable to stroke patients, with low recurrence rates.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Limited data exist on outcomes for patients with transient ischemic attack (TIA) undergoing patent foramen ovale (PFO) closure.
- PFO is a potential cause of cryptogenic stroke and TIA.
Purpose of the Study:
- To evaluate the clinical and procedural characteristics and long-term outcomes of patients with TIA who underwent transcatheter PFO closure.
- To compare outcomes between TIA and stroke patients who underwent PFO closure.
Main Methods:
- A multicenter study of 1,012 patients who underwent PFO closure after a cerebrovascular event.
- Patients were divided into TIA (n=183) and stroke (n=829) groups.
- Median follow-up was 3 years, with 98% completeness.
Main Results:
- No significant differences in clinical characteristics or long-term neurologic event rates between TIA and stroke groups.
- PFO closure was successful in all patients with low complication rates (<1%).
- Recurrent stroke incidence was 0.08 per 100 patient-years in the TIA group vs. 0.17 in the stroke group (p=0.584).
- Recurrent TIA incidence was 0.17 per 100 patient-years in the TIA group vs. 0.28 in the stroke group (p=0.557).
Conclusions:
- Patients with TIA undergoing PFO closure have similar characteristics and outcomes to stroke patients.
- Transcatheter PFO closure is safe and effective for TIA patients, with low long-term recurrence rates.
- Further prospective randomized trials are warranted for this patient population.
Abstract:
Limited data exist on patients with a transient ischemic attack (TIA) who underwent patent foramen ovale (PFO) closure. The objectives of this study were to determine the clinical and procedural characteristics and long-term outcomes of patients with TIA who underwent transcatheter PFO closure. This was a multicenter study including 1,012 consecutive patients who underwent PFO closure after a cerebrovascular event. Patients were divided into 2 groups according to their index event leading to PFO closure: TIA (n = 183 [18%]), and stroke (n = 829 [82%]). The median follow-up was 3 (2 to 8) years (complete in 98% of patients). There were no significant differences between patients with TIA and stroke, except for a lower Risk of Paradoxical Embolism score in the TIA group (6.1 vs 6.9 in the stroke group, p <0.001). PFO closure was successful in all patients with a low rate of complications (<1%) in both groups. There were no differences in the incidence of neurologic events during long-term follow-up. There was 1 stroke event in the TIA group and 6 in the stroke group (0.08 vs 0.17 per 100 patients-years, p = 0.584). There were 2 TIA events in the TIA group and 10 in the stroke group (0.17 vs 0.28 per 100 patients-years, p = 0.557). In conclusion, our study showed that patients with TIA who underwent PFO closure have similar clinical characteristics as patients with stroke including a high Risk of Paradoxical Embolism score. Furthermore, these results suggest that PFO closure procedural results and long-term clinical outcomes are similar to their stroke counterparts, with a very low incidence of recurrent neurologic events. Further prospective randomized clinical trials are needed on this population.
