Endovascular closure of patent foramen ovale for cryptogenic stroke prevention in patients of young age
One of the causes of cryptogenic stroke in young and middle-aged patients is patent foramen ovale (PFO), which enables paradoxical embolism of cerebral arteries by thrombi from systemic veins. According to latest research, endovascular PFO closure is the optimal method for the prevention of further cryptogenic stroke.
From 2011 to 2018 y 10 procedures of endovascular PFO closure with an occluder in young patients with cryptogenic stroke and paradoxical systemic embolism were performed in National M. M. Amosov Institute of Cardiovascular Surgery. The success rate was 100%, and there were no serious complications in the postoperative and long-term periods. All patients are alive and are reporting subjective improvement (headaches and migraines were gone). In one case 1.5 years after the procedure there was reported an MRI-confirmed ischemic stroke, without residual effects. Its most probable reason was embolism with microthrombi from left atrial appendage (there was reported arrhythmia of undetermined etiology in this patient), because both Doppler echocardiography and bubble-test showed no shunt between right and left heart.
Our data confirms the effectiveness and safety of endovascular PFO closure for the prevention of cryptogenic thromboembolism.
3. Saver J. Cryptogenic Stroke / J. Saver // N Engl J Med. – 2016. – Vol. 374, N 21. – P. 2065–2074.
4. The Risk of Paradoxical Embolism (RoPE) Study: developing risk models for application to ongoing randomized trials of percutaneous patent foramen ovale closure for cryptogenic stroke [Електронний ресурс] / Kent D. M., Thaler D. E. // Trials. – 2011. – Vol. 12. – Режим доступу до журналу : https://dx.doi.org/10.1186/1745-6215-12-185
5. Practice advisory: recurrent stroke with patent foramen ovale (update of practice parameter): report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology / Messй S. R., Gronseth G., Kent D. M. [et al.] // Neurology. – 2016. – Vol. 87. – P. 815–821.
6. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association / Kernan W. N., Ovbiagele B., Black H. R. [et al.] // Stroke. – 2014. – Vol. 45. – P. 2160–2236.
7. Closure or medical therapy for cryptogenic stroke with patent foramen ovale / Furlan A. J., Reisman M., Massaro J. [et al.] // N Engl J Med. – 2012. – Vol. 366, N 11. – P. 991–999.
8. Percutaneous closure of patent foramen ovale in cryptogenic embolism / Meier B., Kalesan B., Mattle H. P. [et al.] // N Engl J Med. – 2013. – Vol. 368, N 12. – P. 1083–1091.
9. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke / Saver J., Carroll J., Thaler D. [et al.] // N Engl J Med. – 2017. – Vol. 377, N 11. – P. 1022–1032.
10. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke / Sшndergaard L., Kasner S., Rhodes J. [et al.] // N Engl J Med. – 2017. – Vol. 377, N 11. – P. 1033–1042.
11. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke / Mas J. L., Derumeaux G., Guillon B. [et al.] // N Engl J Med. – 2017. – Vol. 377, N 11. – P. 1011–1021.
12. Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial [Електронний ресурс]/ Lee P. H., Song J.-K., Kim J. S. [et al.] // JACC. – 2018. – Режим доступу до журналу : https://doi.org/10.1016/j. jacc.2018.02.046
13. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials [Електронний ресурс]/ Ahmad Y., Howard J. P., Arnold A. [et al.] // Eur Heart J. – 2018. – Режим доступу до журналу : https://doi.org/10.1093/eurheartj/ehy121
14. Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials [Електронний ресурс] / Kheiri B., Abdalla A., Osman M. [et al.] // Cardiol J. – 2018. – Режим доступу до журналу : http://dx.doi. org/10.5603/CJ.a2018.0016
15. Meta-Analysis Comparing Patent Foramen Ovale Closure Versus Medical Therapy to Prevent Recurrent Cryptogenic Stroke / Ando T., Holmes A. A., Pahuja M. [et al.] // Am J Cardiol. – 2018. – Vol. 121, N 5. – P. 649–655.
16. Percutaneous closure of patent foramen ovale vs. medical treatment for patients with history of cryptogenic stroke: A systematic review and meta-analysis of randomized controlled trials [Електронний ресурс] / Palaiodimos L., Kokkinidis D. G., Faillace R. T. [et al.] // Cardiovasc Revasc Med. – 2018. – Режим доступу до журналу : https://doi.org/10.1016/j.carrev.2018.02.014
17. Transcatheter Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke: A Meta-Analysis of Randomized Controlled Trials / Darmoch F., Al-Khadra Y., Soud M. [et al.] // Cerebrovasc Dis. – 2018. – Vol. 45. – P. 162–169.
18. Cost-effectiveness of percutaneous patent foramen ovale closure as secondary stroke prevention [Електронний ресурс] / Tirschwell D. L., Turner M., Thaler D. [et al.] // J Med Econ. – 2018. – P. 1–20. – Режим доступу до журналу : https://doi.org/10.1080/13696998.2018.1456445
19. Carroll J. D. Structural Heart Disease Interventions / J. D. Carroll, J. G. Webb. – Philadelphia : Lippincott Williams & Wilkins, 2012. – 399 p. – P. 183–189.
20. Transcatheter closure of atrial septal defects. Experimental studies / Lock J. E., Rome J. J., Davis R. [et al.] // Circulation. – 1989. – Vol. 79, N 5. – P. 1091–1099.
21. Transvenous closure of secundum atrial septal defects: preliminary results with a new self-expanding nitinol prosthesis in a swine model / Sharafuddin M. J., Gu X., Titus J. L. [et al.] // Circulation. – 1997. – Vol. 95, N 8. – P. 2162–2168.
22. Incidence and Clinical Course of Thrombus Formation on Atrial Septal Defect and Patient Foramen Ovale Closure Devices in 1,000 Consecutive Patients / Krumsdorf U., Ostermayer S., Billinger K. [et al.] // JACC. – 2004. – Vol. 43, N 2. – P. 302–309.
23. Endocarditis and Incomplete Endothelialization 12 Years after Amplatzer Septal Occluder Deployment / Nguyen A. K., Palafox B. A., Starr J. P. [et al.] // Tex Heart Inst J. – 2016. – Vol. 43, N 3. – P. 227–231.