Recurrent stroke/TIA in cryptogenic stroke patients with patent foramen ovale.
BACKGROUND
Patent foramen ovale (PFO) is present in 40% of patients with cryptogenic stroke and may be associated with paradoxical emboli to the brain. Therapeutic options include antiplatelet agents, anticoagulation, percutaneous device and surgical closure. We assessed the hypothesis that there are differences in rates of recurrent TIA or stroke between patients in the four treatment groups.


METHODS
Patients presenting from January 1997 with cryptogenic stroke or TIA and PFO were followed prospectively until June 2003. Treatment choice was made on an individual case basis. The primary outcome was recurrent stroke. The secondary outcome was a composite of stroke, TIA, and vascular death.


RESULTS
Baseline. Our cohort consisted of 121 patients; 64 (53%) were men. Median age was 43 years. Sixty-nine percent presented with stroke and 31% with TIA. One or more vascular risk factor was present in 40%. Atrial septal aneurysm (ASA) was present in 24%. Treatment consisted of antiplatelet agents (34%), anticoagulation (17%), device (39%) and surgical closure (11%). Follow-up. Recurrent events occurred in 16 patients (9 antiplatelet, 3 anticoagulation, 4 device closure); 7 were strokes, 9 were TIA. Comparing individual treatments there was a trend toward more strokes in the antiplatelet arm (p = 0.072); a significant difference was seen for the composite endpoint (p = 0.012). Comparing closure versus combined medical therapy groups, a significant difference was seen for primary (p = 0.014) and secondary (p = 0.008) outcomes, favoring closure. Age and pre-study event predicted outcome.


CONCLUSIONS
Patent foramen ovale closure was associated with fewer recurrent events. Complications of surgical and device closure were self-limited.
Casaubon
Leanne
L
University Health Network, Toronto General Hospital, ON, Canada.
McLaughlin
Peter
P
Webb
Gary
G
Yeo
Erik
E
Merker
Darren
D
Jaigobin
Cheryl
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015984:Causality; D015331:Cohort Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors