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Clinical research

Predictors of recurrent stroke after percutaneous closure of patent foramen ovale

1. University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany; 2. Heart Center, University of Cologne, Cologne, Germany; 3. Department of Cardiology, Hospital Pinneberg, Pinneberg, Germany; 4. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; 5. Department of Internal Medicine, Johanniter Hospital, Geesthacht, Germany; 6. Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Aims: Closure of patent foramen ovale following presumed paradoxical embolic stroke remains controversial. The answer to the question as to whether cardiovascular risk factors (CVRF) impact on the recurrence of stroke in patients who have undergone PFO closure remains elusive so far. We aimed to investigate the potential impact of CVRF on the long-term rate of stroke/TIA recurrence in patients treated with an occluder following presumed paradoxical embolic stroke.

Methods and results: 443 patients (mean age: 50.0±12.6 yrs, female: 206 [46.5%]) undergoing percutaneous PFO closure after presumed paradoxical embolic stroke were followed for a median time of 43.0 [interquartile range: 20.0-86.0] months. During the follow-up period a total of 22 (5.0%) strokes/TIAs and 17 (3.8%) deaths were observed. Cox regression analysis identified hypertension, age and the Essen stroke risk score as predictors of recurrent stroke/TIA.

Conclusions: This study shows that, in patients with a prior presumed paradoxical embolic stroke, the risk for recurrent stroke/TIA after PFO closure is firmly linked to the presence of CVRF.

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