Stroke and transient ischemic attack recurrence after PFO closure in patients with cryptogenic embolism.

BACKGROUND

Patent foramen ovale (PFO) closure is recommended in selected patients with a cryptogenic stroke and a PFO, as multiple randomized controlled trials (RCTs) have shown superiority of PFO closure over medical therapy in reducing recurrent stroke risk. However, follow-up data outside clinical trials remains scarce. The aim of this study is to evaluate the stroke/transient ischemic attack (TIA) recurrence after PFO closure.

METHODS

Data from 242 patients who underwent PFO closure at the University Medical Centre Groningen (UMCG) between February 2016 and June 2023, because of a cryptogenic stroke, TIA, or peripheral embolism, were collected.

RESULTS

During a median follow-up of 3.1 years (IQR: 1.9-4.3), a total of 5 recurrent strokes (0.70 per 100 person-years) and 11 recurrent TIAs (1.54 per 100 person-years) were documented. In patients with a recurrent neurological event, hypertension was more prevalent (30.8% vs. 9.6%, p = 0.040). Atrial fibrillation (AF) or atrial flutter was seen in 5.7% of the patients. Other adverse events were rare.

CONCLUSION

In this study, the rate of recurrent stroke/TIA after PFO closure was low, but higher than reported in previous studies. These elevated values are primarily due to the higher risk of recurrent TIA, as the recurrent stroke risk in our cohort is comparable to that reported in RCTs. Hypertension was significantly associated with the recurrence of a stroke/TIA.