Abstract Details

Title Patent Foramen Ovale Closure for Secondary Stroke Prevention in Patients Aged 60 or Older Is Safe

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-011

Objective To assess the comparative safety of patent foramen ovale (PFO) closure for secondary stroke prevention in a population of patients aged 60 or older in the United States.

Background

Paradoxical embolism via PFO is a known etiology of cryptogenic ischemic stroke. RESPECT, DEFENSE-PFO, REDUCE and CLOSE trials showed that closing PFO is superior to medical treatment for stroke prevention in patients younger than 60.

Design/Methods This is an IRB approved retrospective review of all patients who underwent PFO closure for secondary stroke prevention by two cardiology services at a comprehensive stroke center. Data reviewed and analyzed included demographics, Spencer grades, TEE and TTE findings, and peri-procedural adverse events. Safety data was compared to the published results of RESPECT and REDUCE trials. Descriptive statistics were applied, and Fisher's Exact Test was used for the comparisons.

Results From 1/2021 to 1/2023, data of 24 patients meeting criteria was included in the analysis. They consisted of 9 (38%) male and 4 (17%) Hispanic with average age 69 (range 60-82). Ten (42%) patients had a Spencer Grade 4. The average baseline NIHSS score was 5.7. Atrial fibrillation or flutter was reported in 3 (12.5%) study patients compared to 0.6% in RESPECT (p=0.002) and 6.6% in REDUCE (p=0.224). Other tracked adverse event rates did not significantly differ.

Conclusions Our study showed that observed PFO closure adverse event rates in patients age ≥ 60 are statistically indifferent from patients age < 60 except for occurrence of atrial fibrillation. The increased rate of atrial fibrillation may be partly explained by an increased baseline rate of atrial fibrillation and trial variation in arrhythmia monitoring methods. Subsequent prospective RCTs are warranted with post procedural cardiac monitoring for at least 45 days (83% atrial fibrillation or flutter capture in REDUCE) to examine the efficacy and safety of closing PFO in patients > 60.

Authors/Disclosures
Brandon May, MD (Barrow Neurological Institute) PRESENTER	Dr. May has nothing to disclose.
Vijendra Swarup	No disclosure on file
Hursh Naik	No disclosure on file
Michael F. Waters, MD, PhD, FAAN (Mount Sinai Scholl of Medicine)	Dr. Waters has nothing to disclose.
Daniel Gonzalez, MD (Barrow Neurological Institute)	Dr. Gonzalez has nothing to disclose.
Supreet Kaur, MD	Dr. Kaur has nothing to disclose.
Lynn S. Ashby, MD	Dr. Ashby has nothing to disclose.
Patricia Teran (Privia health)	Patricia Teran has nothing to disclose.
Tracie Schroeder (Barrow Neurological Institute)	Tracie Schroeder has nothing to disclose.
Tiffany Sheehan	No disclosure on file
Emily Mawk (Arizona Heart Rhythm Center)	No disclosure on file
David Z. Wang, DO, FAHA, FAAN (BNI, Neurology, Stroke)	Dr. Wang has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Mediwelcome.

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