Selection of patients for percutaneous closure in nonlacunar cryptogenic stroke associated with patent foramen ovale. Data from the NORDICTUS cooperative registry.

Abstract

INTRODUCTION:

There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure.

METHOD:

A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischaemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/> 60 years) and the characteristics of the PFO.

RESULTS:

In the group ≤ 60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P < .001), criteria for paradoxical embolism (OR 2.61; IC 1.28-5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38-5.18; P = .009). In the > 60 years group (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria, and high-risk PFO.

CONCLUSIONS:

The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.

• Authors: J Tejada García, L B Lara Lezama, R de la Fuente Blanco, A Pérez de Prado, L Benavente Fernández, M Rico Santos, M D Fernández Couto, L Naya Ríos, I Couso Pazó, P V Alba, L Redondo-Robles, L López Mesonero, S Arias-Rivas, M Santamaría Cadavid, H Tejada Meza, L Horna Cañete, I Azkune Calle, A Pinedo Brochado, J M García Sánchez, I Caballero Romero, M M Freijo Guerrero, A Luna Rodríguez, M de Lera-Alfonso, J F Arenillas Lara, C Pérez Lázaro, M P Navarro Pérez, M Martínez Zabaleta
• Journal: Neurologia (Barcelona, Spain) (Neurologia (Engl Ed)) (Nov 05 2022) ISSN: 2173-5808 [Electronic] Spain
• PMID: 36347422 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.