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Abstract Details

PFO Closure in Older Patients with Embolic Stroke of Undetermined Source
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (11:45 AM-12:45 PM)
5-010
We aim to investigate the benefit of patent foramen ovale (PFO) closure in older patients with embolic stroke of undetermined source (ESUS). Patients were carefully selected after an evaluation by a group of neurologists and cardiologists.

PFO closure is recommended for patients younger than 60 years with ESUS. However, the role of PFO closure in patients older than 60 years is unclear.
This single-center observational study recruited patients older than 60 years with ESUS, who had a PFO closure following presumed PFO-related ischemic stroke. The primary outcome was a composite of recurrent ischemic stroke, transient ischemic attack, or fatal stroke that occurred up to 5 years following PFO closure. The safety outcome was the occurrence of any complications after a PFO closure, including new-onset atrial fibrillation (AF).

A total of 64 patients were included (mean age 65.4±5.2), 39 of which were male (61.9%). Mean RoPE score was 4. Procedure-related complications, including new onset AF were low (1.6%). After a median follow-up of 2.4 years, patients older than 60 years demonstrated a high incidence of recurrent ischemic stroke (6.3%, 4/64), recurrent transient ischemic attack (3.1%, 2/64), but no recurrent fatal stroke (0%, 0/64) as their younger (age<60) counterparts (1.5% overall recurrent cerebrovascular events from 6 clinical trials). However, there was an overall 98.3% freedom from a recurrent stroke following PFO closure (95% CI: 88.4%, 99.8%) in this older population with ESUS.

In patients with cryptogenic stroke who are older than 60 years, PFO closure demonstrated similar safety profiles but was associated with a relatively high risk of recurrent ischemic stroke compared to their younger counterparts reported in previous 6 trials (CLOSE, CLOSURE-I, DEFENCE-PFO, REDUCE, RESPECT and PC Trial). Randomized trials compared to same-age patients are warranted in this population.
Authors/Disclosures
Dania Mallick, MBBS
PRESENTER 		Dr. Mallick has nothing to disclose.
Ana T. Torres, NP Miss Torres has nothing to disclose.
Mohammad Ahmed No disclosure on file
Alan T Davis No disclosure on file
Brandon Vieder, DO Dr. Vieder has nothing to disclose.
Asad Ahrar, MD (Corwell Health) Dr. Ahrar has nothing to disclose.
Nadeem I. Khan, MD (Spectrum Health) Dr. Khan has nothing to disclose.
Malgorzata Miller, MD (Corewell Health) The institution of Dr. Miller has received research support from NIH StrokeNet VERIFY trial.
Nabil Wees, MD (Augusta University) Dr. Wees has nothing to disclose.
Elizabeth Evans, NP (Spectrum Health Medical Group) Mrs. Evans has nothing to disclose.
Muhib Khan, MD, FAAN (Mayo Clinic) The institution of Dr. Khan has received research support from Mayo Clinic 好色先生 Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
Jiangyong Min, MD (Corewell Health West) Dr. Min has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic . Dr. Min has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for CredentialMed, LLC. The institution of Dr. Min has received research support from Corerwell Health Foundation .