Percutaneous Closure of Patent Foramen Ovale in Ischemic Stroke: A Single-Center Experience

The prevalence of patent foramen ovale (PFO) is higher in patients who have experienced a cryptogenic ischemic stroke. Recent trials have demonstrated the efficacy of PFO closure in preventing recurrent cerebrovascular events. This study evaluated the clinical outcomes of percutaneous PFO closure at a tertiary center in Northern Taiwan.

A total of 21 patients underwent transcatheter PFO closure between 2014 and 2022. Eighteen patients with a history of ischemic stroke or transient ischemic attack were further analyzed to assess their stroke risk, imaging studies, perioperative adverse events, and post-procedure outcomes. The follow-up period spanned from 2014 to 2023.

Of the 18 patients, the proportion of males was higher (79%), and the average age was 48.4 years. Dyslipidemia was the most common comorbidity (50%), and 44.4% of the patients had cerebral vascular stenosis. The most common intra-operative event was premature atrial contractions. Post-procedure adverse events included headache, local hematoma, chest tightness, and bradycardia. During follow-up, three patients (16.7%) had recurrent cerebrovascular events, potentially associated with intracranial arterial stenosis as seen in brain imaging. The average recurrence rate of stroke after PFO closure was 3.5 events per 100 patient-years.

Transcatheter PFO closure could be considered as secondary prevention for patients younger than 60 years with cryptogenic ischemic stroke. The underlying diseases and anatomic features of PFO should be evaluated comprehensively to inform shared decision-making. Post-procedure follow-up includes evaluating cardiac arrhythmia and underlying diseases contributing to cerebrovascular stenosis, as they may be associated with recurrent stroke.