Abstract 15008: Multi-Disciplinary Approach to Patent Foramen Ovale and Cryptogenic Stroke or Transient Ischemic Attack.
Purpose: Patent foramen ovale (PFO) has been implicated as a risk factor for cryptogenic ischemic stroke. We have performed percutaneous closure of PFO since 1998 to reduce the risk of recurrent stroke in selected patients. Due to the complexity of cryptogenic stroke and the lack of widely accepted, undisputed indications, a multi-disciplinary approach has been formalised in a devoted PFO conference where decisions are made by consensus.
Methods: The PFO conference is a recurrent meeting where specialists in neurology, cardiology and internal medicine discuss clinical data, etiology and make a morphological risk evaluation for each patient. A standardised protocol addressing risk factors, medication, indication for closure and exclusion criteria has been developed. In this study we report data for all patients discussed at PFO conferences during 2006 to 2009.
Results: 311 patients were evaluated at the PFO conference. Patients were only considered for PFO closure where a confirmed diagnosis of cryptogenic stroke or transient ischemic attack (TIA) had been made. Patients with a first ever cryptogenic stroke with high-risk morphology or recurrent cryptogenic stroke with low-risk morphology were accepted. We accepted 143 patients for closure (100 men and 43 women), 168 patients were not accepted (93 men and 75 women). Acceptance rates were 43% (2006), 42% (2007), 52% (2008) and 42% (2009). Patients accepted for closure were younger (mean 50 years vs. 58 years, p<0,001). Median age for men was 51 years and women 48 years in the accepted group vs. 57 years for men and 58 years for women in the group which were not accepted for PFO closure. Based on our criteria 3 patients that were considered to have a low risk of recurrence and denied closure after their primary event were referred again after a second cerebrovascular event.
Conclusions: The fact that less than 50% of referred patients fulfilled our criteria for PFO closure in the present study underscores the complex relationship between cryptogenic stroke and PFO. In conclusion, for a proper assessment of PFO as a risk factor for cryptogenic stroke, a standardised multidisciplinary approach is necessary.
- © 2010 by American Heart Association, Inc.