title: Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.
abstract: Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke.
authors.affiliation: Department of Accident and Emergency, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Mikaeil
authors.initials: M
authors.lastname: Mirzaali
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Maureen
authors.initials: M
authors.lastname: Dooley
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Dylan
authors.initials: D
authors.lastname: Wynne
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Nina
authors.initials: N
authors.lastname: Cooter
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Haworth
authors.affiliation: Department of Neurology, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: Romi
authors.initials: R
authors.lastname: Saha
authors.affiliation: Department of Elderly Medicine, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gainsborough
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: patent foramen ovale; percutaneous closure; stroke; transient ischaemic attack