Elsevier

The American Journal of Cardiology

Volume 187, 15 January 2023, Pages 148-153
The American Journal of Cardiology

Transcatheter Patent Foramen Ovale Closure in Patients With Transient Ischemic Attack

https://doi.org/10.1016/j.amjcard.2022.10.044Get rights and content

Limited data exist on patients with a transient ischemic attack (TIA) who underwent patent foramen ovale (PFO) closure. The objectives of this study were to determine the clinical and procedural characteristics and long-term outcomes of patients with TIA who underwent transcatheter PFO closure. This was a multicenter study including 1,012 consecutive patients who underwent PFO closure after a cerebrovascular event. Patients were divided into 2 groups according to their index event leading to PFO closure: TIA (n = 183 [18%]), and stroke (n = 829 [82%]). The median follow-up was 3 (2 to 8) years (complete in 98% of patients). There were no significant differences between patients with TIA and stroke, except for a lower Risk of Paradoxical Embolism score in the TIA group (6.1 vs 6.9 in the stroke group, p <0.001). PFO closure was successful in all patients with a low rate of complications (<1%) in both groups. There were no differences in the incidence of neurologic events during long-term follow-up. There was 1 stroke event in the TIA group and 6 in the stroke group (0.08 vs 0.17 per 100 patients-years, p = 0.584). There were 2 TIA events in the TIA group and 10 in the stroke group (0.17 vs 0.28 per 100 patients-years, p = 0.557). In conclusion, our study showed that patients with TIA who underwent PFO closure have similar clinical characteristics as patients with stroke including a high Risk of Paradoxical Embolism score. Furthermore, these results suggest that PFO closure procedural results and long-term clinical outcomes are similar to their stroke counterparts, with a very low incidence of recurrent neurologic events. Further prospective randomized clinical trials are needed on this population.

Section snippets

Methods

This was a study including consecutive patients who had transcatheter PFO closure after a cryptogenic thromboembolic event between 2001 and 2020 in 2 high-volume tertiary-care University centers in Canada and France.

Patients were divided into 2 groups according to their primary PFO-related event (stroke or TIA). The stroke diagnosis was confirmed with either computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. The diagnosis of TIA was made following its previously

Results

Of 1,136 consecutive patients who underwent PFO closure, 124 (11%) had indications other than stroke or TIA and were excluded. Of the remaining 1,012 patients, 183 (18%) and 829 (82%) patients had transcatheter PFO closure because of a TIA and a stroke event, respectively. The baseline characteristics of both groups are summarized in Table 1. There were no significant differences between patients with TIA and stroke, except for a lower Risk of Paradoxical Embolism (RoPE) score in the TIA group

Discussion

The main findings of this study can be summarized as follows: (1) patients with a diagnosis of cryptogenic TIA presented the same clinical profile as those with stroke except for a slightly lower RoPE score, (2) transcatheter PFO closure was a safe procedure for patients with a PFO-related TIA, as shown by the low rate of procedural complications and the success rate of 100%, and (3) transcatheter PFO closure in patients with a PFO-related TIA may be effective as in patients with a PFO-related

Acknowledgment

Dr. Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions.

Disclosures

The authors have conflicts of interest to declare.

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Funding: none.

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