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Predictors of recurrent cerebral ischemia after patent foramen ovale closure: A single center observational study
Filippo Luca Gurgoglione1, Luigi Vignali2, Maria Alberta Cattabiani2
1Department of Medicine and Surgery, University of Parma, Parma, Italy.
Insights
Transcatheter patent foramen ovale closure is effective, but recurrent strokes can occur. Obesity, a low Risk of Paradoxical Embolism score, and migraine are key predictors of these events post-procedure.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Transcatheter patent foramen ovale (PFO) closure is a recognized treatment for reducing recurrent stroke in select patients.
- However, the incidence of recurrent ischemic events post-procedure remains a concern, with underlying causes not fully understood.
Purpose of the Study:
- To determine the prevalence of recurrent ischemic neurological events after PFO closure.
- To identify independent predictors of these recurrent events.
Main Methods:
- A cohort of 169 patients undergoing PFO closure for secondary stroke prevention was analyzed.
- Clinical data and procedure details were collected, and recurrent ischemic events were tracked during follow-up.
Main Results:
- Recurrent cerebral ischemia occurred in 8.4% of patients (n=154) after a median follow-up of 112 months (annualized rate: 0.92/100 patients).
- Independent predictors for recurrent events included obesity (OR 5.268), a Risk of Paradoxical Embolism score < 7 (OR 5.991), and migraine (OR 5.932).
Conclusions:
- Obesity, a low Risk of Paradoxical Embolism score, and migraine are significant independent predictors of recurrent ischemic neurological events following PFO closure.
- These findings highlight specific patient characteristics that may warrant closer monitoring or further investigation after PFO closure.
Objectives:
Transcatheter patent foramen ovale closure lowers recurrent stroke in patients with cryptogenic stroke or transient ischemic attack with an indication for closure. However, the incidence of recurrent stroke is not negligible and underlying pathophysiology remains largely unknown. We sought to evaluate the prevalence of recurrent ischemic neurological events and to assess its predictors after transcatheter patent foramen ovale closure.
Methods:
We enrolled consecutive patients who underwent patent foramen ovale closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2006 and 2021. Clinical and procedure-related features were collected for each patient. The incidence of recurrent ischemic neurological events was assessed at follow-up.
Results:
We enrolled a total of 169 patients with mean Risk of Paradoxical Embolism score at hospital admission of 6.4 ± 1.5. The primary indication was previous cryptogenic stroke (94 [55.6 %] subjects), followed by transient ischemic attack (75 [44.4 %]). Among patients with complete outcome data (n= 154), after a median follow-up of 112 months, recurrent cerebral ischemia occurred in 13 [8.4 %], with an annualized rate of 0.92/100 patients. The presence of obesity [OR 5.268, p = 0.018], Risk of Paradoxical Embolism score < 7 [OR 5.991, p = 0.035] and migraine [OR = 5.932 p = 0.012] were independent positive predictors of recurrent stroke/ transient ischemic attack after patent foramen ovale closure.
Conclusions:
The presence of obesity, Risk of Paradoxical Embolism score < 7 and migraine were independent positive predictors of recurrent ischemic neurological events after patent foramen ovale closure.
