PURPOSE: Patent Foramen Ovale (PFO) is an important part of evaluation of cryptogenic stroke not only in younger patients but also in older population. Therapeutic options for secondary stroke prevention in patients with PFO include medical therapy with antiplatelet agents or anticoagulation, and surgical or percutaneous closure of the defect. We evaluated different treatment strategies and its impact on in-hospital mortality and major adverse outcomes.
METHODS: In this retrospective study, we reviewed the medical charts and electronic records of 24 patients with age > 50 years who were admitted from January-2005 to August 2006 with diagnosis of cryptogenic stroke probably due to PFO. Patients in medical treatment group received warfarin alone or aspirin and clopidogrel. In closure group, patients underwent percutaneous PFO closure. Categorical data were analysed using Fisher's exact test. Primary outcome was in-hospital deaths and mortality at 12 months follow-up. Secondary outcomes were major adverse cardiovascular events(MACE), which included stroke, transient-ischemic attack, or major bleed.
RESULTS: There was no in-hospital death seen in either cohort. Seven percent mortality was seen in medical management group, and no patient died in surgical treatment group at one year follow-up. (p=ns). Mean age of the patients was 56 years. MACE was seen in 2 (20%) patients in closure group and 2 (14.3%) in medical treatment group at one year follow-up. (p=ns).
CONCLUSION: Cryptogenic stroke patients with PFO who underwent medical management or percutaneous closure for secondary stroke prevention, no statistically significant difference was noted in terms of death or MACE at time of hospital discharge or one year follow-up.
CLINICAL IMPLICATIONS: PFO has been described in 25 to 30 percent of individuals. The prevalence has increased in patients with cryptogenic stroke. For a PFO to be responsible for a cryptogenic stroke, the pressure in the right atrium must be greater than that in the left atrium to permit right-to-left shunting. Larger randomized control trials are needed to justify superiority of one modality of treatment over another.
DISCLOSURE: Naveet Bal, No Financial Disclosure Information; No Product/Research Disclosure Information