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Percutaneous PFO closure yields similar benefits as medical therapy in patients with stroke
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Percutaneous, catheter-based closure of patent foramen ovale was as effective as medical therapy for secondary prevention of cryptogenic ischemic stroke, according to findings published in Circulation: Cardiovascular Interventions.
Alessandro Pezzini, MD, from the department of clinical and experimental sciences, neurology clinic, University of Brescia, Italy, and colleagues assessed in a propensity-scored study the outcomes of percutaneous closure vs. medical therapy alone for the secondary prevention of embolism in patients with PFO and otherwise unexplained ischemic stroke.
A composite of ischemic stroke, transient ischemic attack or peripheral embolism was the primary endpoint, whereas brain ischemia was the secondary endpoint.
The researchers analyzed data from 1,906 patients aged 18 to 45 years in the Italian Project on Stroke in Young Adults (IPSYS) registry between 2000 and 2012. Of those, 521 patients were included in the analysis.
Based on physician choice and patient preference, 206 patients underwent percutaneous PFO closure, whereas 315 were given medical therapy.
Seven percent of patients treated with percutaneous PFO closure reached the primary endpoint compared with 10.5% receiving medical therapy (HR = 0.72; 95% CI, 0.39-1.32), according to the researchers. The secondary endpoint was reached in 6.3% of patients undergoing percutaneous PFO closure vs. 10.2% with medical-therapy treatment (HR = 0.64; 95% CI, 0.33-1.21).
Researchers also found that percutaneous PFO closure benefited patients with a substantial right-to-left shunt size (HR = 0.19; 95% CI, 0.05-0.68), as well as patients aged 18 to 36 years (HR = 0.19; 95% CI, 0.04-0.81). The researchers called for further study for the latter two results. – by James Clark
Disclosure: The researchers report no relevant financial disclosures.
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