title: Recurrent cerebral ischemia after patent foramen ovale percutaneous closure in older patients: A two-center registry study.
abstract: OBJECTIVE
  The aim of this study is to describe the cerebral ischemia recurrence rate after percutaneous patent foramen ovale (PFO) closure in patients older than 55 years and their outcomes, compared with younger patients.
  
  
  BACKGROUND
  The registries data and the recent randomized trials about PFO closure are focused on patients younger than 55 years. Little is known about older patients' long-term outcome.
  
  
  METHODS
  In total, 458 patients underwent PFO closure for cryptogenic cerebral ischemia and were stratified into an "older" (≥ 55 years, 151 patients) and a "younger" (<55 years, 307 patients) group.
  
  
  RESULTS
  Older patients had mean age of 63 ± 6 years and more atrial septum aneurysm (P = 0.05), hypertension, diabetes, and dyslipidemia (P = 0.001). Mean followup was 4.5 ± 2.8 years. Older patients had a higher rate of ischemic recurrence (0.3 vs. 4.0%, P = 0.002), after a mean time of 3.1 ± 2.6 years. The Kaplan-Meier curve confirmed higher event-free survival in the youngers (P = 0.008). None of the patients with ischemic recurrence had significant residual shunt. Age and hypertension were correlated to ischemic recurrence, but age was the only independent predictor at multivariate analysis.
  
  
  CONCLUSIONS
  Recurrent cerebral ischemia after PFO closure is more frequent in older patients and could most likely be associated to conditions related to age (atherosclerosis, atrial fibrillation), than to paradoxical embolism. The procedure is as safe as in younger patients.
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scacciatella
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Meynet
authors.affiliation: Department of Invasive Cardiology, Istituto Di Ricovero E Cura a Carattere Scientifico Istituto Clinico Humanitas, Rozzano, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Giorgi
authors.affiliation: Department of Invasive Cardiology, Istituto Di Ricovero E Cura a Carattere Scientifico Istituto Clinico Humanitas, Rozzano, Milan, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Lucarelli
authors.affiliation: Department of Invasive Cardiology, Istituto Di Ricovero E Cura a Carattere Scientifico Istituto Clinico Humanitas, Rozzano, Milan, Italy.
authors.forename: Dennis
authors.initials: D
authors.lastname: Zavalloni Parenti
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Lorenza Michela
authors.initials: LM
authors.lastname: Biava
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
mesh_terms: D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: cryptogenic stroke; secondary stroke prevention; structural heart intervention