Device Closure or Antithrombotic Therapy After Cryptogenic Stroke in Elderly Patients With a High-Risk Patent Foramen Ovaleopen access
- Authors
- Pil Hyung Lee; Jung-Sun Kim; Jae-Kwan Song; Sun U. Kwon; Bum Joon Kim; Ji Sung Lee; Byung Joo Sun; Jong Shin Woo; Soe Hee Ann; Jung-Won Suh; Jun Yup Kim; Kyusup Lee; Sang Yeub Lee; Ran Heo; Soo Jeong; Jeong Yoon Jang; Jang-Whan Bae; Young Dae Kim; Sung Hyuk Heo; Jong S. Kim
- Issue Date
- May-2024
- Publisher
- 대한뇌졸중학회
- Keywords
- Cryptogenic stroke; Patent foramen ovale; Device closure; Stroke prevention; Elderly patients
- Citation
- 대한뇌졸중영문학회지, v.26, no.2, pp 242 - 251
- Pages
- 10
- Journal Title
- 대한뇌졸중영문학회지
- Volume
- 26
- Number
- 2
- Start Page
- 242
- End Page
- 251
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/74078
- DOI
- 10.5853/jos.2023.03265
- ISSN
- 2287-6391
2287-6405
- Abstract
- Background and Purpose In young patients (aged 18–60 years) with patent foramen ovale (PFO)- associated stroke, percutaneous closure has been found to be useful for preventing recurrent ischemic stroke or transient ischemic attack (TIA). However, it remains unknown whether PFO closure is also beneficial in older patients.Methods Patients aged ≥60 years who had a cryptogenic stroke and PFO from ten hospitals in South Korea were included. The effect of PFO closure plus medical therapy over medical therapy alone was assessed by a propensity-score matching method in the overall cohort and in those with a high-risk PFO, characterized by the presence of an atrial septal aneurysm or a large shunt.Results Out of the 437 patients (mean age, 68.1), 303 (69%) had a high-risk PFO and 161 (37%) patients underwent PFO closure. Over a median follow-up of 3.9 years, recurrent ischemic stroke or TIA developed in 64 (14.6%) patients. In the propensity score-matched cohort of the overall patients (130 pairs), PFO closure was associated with a significantly lower risk of a composite of ischemic stroke or TIA (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.24–0.84; P=0.012), but not for ischemic stroke. In a subgroup analysis of confined to the high-risk PFO patients (116 pairs), PFO closure was associated with significantly lower risks of both the composite of ischemic stroke or TIA (HR: 0.40; 95% CI: 0.21–0.77; P=0.006) and ischemic stroke (HR: 0.47; 95% CI: 0.23–0.95; P=0.035).
Conclusion Elderly patients with cryptogenic stroke and PFO have a high recurrence rate of ischemic stroke or TIA, which may be significantly reduced by device closure.
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