Abstract | OBJECTIVES: BACKGROUND: The exact role for transcatheter closure of PFO in migraine therapy has yet to be elucidated. METHODS: We enrolled 86 patients (68 female, mean age 40.0 +/- 3.7 years) referred to our center over a 48-month period for a prospective study to evaluate severe, disabling, medication-refractory migraine and documented PFO. The Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine. Criteria for intervention included all of the following: basal shunt and shower/curtain shunt pattern on transcranial Doppler and echocardiography, presence of interatrial septal aneurysm and Eustachian valve, 3 to 4 class MIDAS score, coagulation abnormalities, and medication-refractory migraine with or without aura. RESULTS: On the basis of our inclusion criteria, we enrolled 40 patients (34 females, mean age 35.0 +/- 6.7 years, mean MIDAS 35.8 +/- 4.7) for transcatheter PFO closure; the remainder continued on previous medical therapy. Percutaneous closure was successful in all cases, with no peri-procedural or in-hospital complications. After a mean follow-up of 29.2 +/- 14.8 months (range 6 to 48 months), PFO closure was complete in 95%; all patients (100%) reported improved migraine symptomatology (mean MIDAS score 8.3 +/- 7.8, p < 0.03). Specifically, auras were eliminated in 100% of patients after closure. CONCLUSIONS: Primary transcatheter PFO closure resulted in a very significant reduction in migraine in patients satisfying our criteria.
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Authors | Gianluca Rigatelli, Fabio Dell'Avvocata, Federico Ronco, Paolo Cardaioli, Massimo Giordan, Gabriele Braggion, Silvio Aggio, Mauro Chinaglia, Giorgio Rigatelli, Jack P Chen |
Journal | JACC. Cardiovascular interventions
(JACC Cardiovasc Interv)
Vol. 3
Issue 3
Pg. 282-7
(Mar 2010)
ISSN: 1876-7605 [Electronic] United States |
PMID | 20298985
(Publication Type: Clinical Trial, Journal Article)
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Copyright | Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Blood Coagulation Tests
- Cardiac Catheterization
(adverse effects, instrumentation)
- Chi-Square Distribution
- Disability Evaluation
- Echocardiography, Transesophageal
- Embolism, Paradoxical
(diagnosis, etiology, prevention & control)
- Female
- Foramen Ovale, Patent
(complications, diagnosis, drug therapy, therapy)
- Humans
- Male
- Migraine with Aura
(diagnosis, etiology, prevention & control)
- Migraine without Aura
(diagnosis, etiology, prevention & control)
- Patient Selection
- Prospective Studies
- Prosthesis Design
- Risk Assessment
- Risk Factors
- Septal Occluder Device
- Severity of Illness Index
- Time Factors
- Treatment Outcome
- Ultrasonography, Doppler, Transcranial
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