MiscellaneousClinical and Brain Magnetic Resonance Imaging Follow-up After Percutaneous Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke
Section snippets
Methods
The study population comprised 71 consecutive patients <60 years old who underwent transcatheter closure of a PFO at our institution from June 2003 to January 2006. All patients had (1) a large PFO with spontaneous or inducible atrial right-to-left shunt documented by contrast transcranial Doppler ultrasound (TCD) and transesophageal echocardiography, (2) ≥1 ischemic stroke or transient ischemic attack with MRI documentation of the index event, and (3) no alternative cardiac, aortic, or
Results
Clinical characteristics of our study population are presented in Table 1. All 71 patients had large right-to-left shunt at TCD (grade ≥3); grade 4 was present in 20 patients (28%); grade 5 was present in 13 patients (18%); 16 patients (23%) had ASA at transesophageal echocardiography and 12 of these (75%) had a grade 4 or 5 shunt; concomitant coagulation disorders were present in 10 patients (14%). Considering clinically manifest and silent events together, >1 event was present in 22 patients
Discussion
The present study, exploiting careful clinical and imaging follow-up, shows that percutaneous closure of a large PFO results in very few relapses and thus may offer very favorable clinical benefits that should be definitively established by a large randomized clinical trial. In addition, our original brain MRI follow-up data show that new silent brain lesions very rarely occur after PFO occluder device implantation, in striking contrast to the relatively high rate of events before PFO closure
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Cited by (14)
Residual shunt after patent foramen ovale closure: Preliminary results from italian patent foramen ovale survey
2013, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :rRLS was evident in about 20% of patients at the 6- and 12-month follow-up. These data are in line with those present in the literature,3-19,28-30 even if these appear highly variable, even rising to 33% of rRLS.16 It might thus depend on the entire number of population studied in those reports and the method utilized for RLS detection.
Dementia, stroke and migraine - Some common pathological mechanisms
2010, Journal of the Neurological SciencesCitation Excerpt :In this case, paradoxical embolization may be the causal link between migraine and PFO, but solid evidence is lacking if migraine frequency and thus ischaemic stroke are reduced by the PFO closure. One prospective, randomized, double-blind study suggested a reduction of headache days after PFO closure relative to the sham group [144] and an improvement was seen after the procedure in patients with subclinical WMLs [145]. These observations suggest that PFO–migraine–stroke is a possibility, but further evidence is needed to confirm this theory.
Improvement of Migraine After Patent Foramen Ovale Percutaneous Closure in Patients With Subclinical Brain Lesions. A Case-Control Study
2009, JACC: Cardiovascular InterventionsCitation Excerpt :We achieved TCDD according to the recommendations of the Venice Consensus Conference (18). On the basis of microembolic signals (MES) count, we adopted a previously described 6-level scale for classification of shunt (19): 0 = absence of shunt (0 MES); 1 = latent shunt of mild degree (1 to 20 MES) after Valsalva maneuver (VM); 2 = latent shunt of moderate degree (>20 MES after VM, without curtain); 3 = latent shunt of high degree (curtain after VM); 4 = permanent shunt of mild/moderate degree (>10 MES at rest and curtain after VM); 5 = permanent shunt of high degree (curtain at rest). All patients recruited had a large RLS (at least grade 3 at TCCD).
Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure
2020, International Journal of Cardiovascular Imaging