Sustained risk of recurrent thromboembolic events in patients with patent foramen ovale and paradoxical embolism: long-term follow-up over more than 15 years
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Patients with patent foramen ovale (PFO) and cryptogenic stroke are at risk of recurrence. Therapeutic regimens range from no treatment to anticoagulation treatment to surgical or interventional closure. However, long-term follow-up is only available for up to 4 years.
Among ~5,000 transesophageal echocardiographies in stroke/TIA-patients between 1988 and 1997, a PFO was found and considered a possible mediator for the neurological event in 97 patients. In these patients, the PFO was judged to be responsible for the neurological event. Patients with cardiac or other reasons for embolism were excluded. The therapy for stroke was chosen by the attending physician. Follow-up information was obtained through telephone interviews.
Follow-up was available for 86 patients (89%) with a mean period of 15.4 years (range, 11.2–25.9 years). Thirteen patients (15%) suffered from recurrent ischemic events (7 TIAs, 5 strokes, 1 peripheral embolism) after a mean period of 4.9 years. Four patients died, not associated with recurrent thromboembolism. The risk of recurrence was increased over the entire length of the mean follow-up period. The occurrence of recurrent events was not associated with differences in baseline data, the presence of ASA, PFO size or the chosen treatment.
In patients with paradoxical embolism, recurrent ischemic events are frequent despite medical therapy. These events are not limited to the early years after the index event; this long-term follow-up revealed a risk of occurrence over the entire follow-up. These patients have a sustained risk of recurrence, requiring lifetime protection, which should be considered in tailoring individual therapeutic strategies.
KeywordsPatent foramen ovale Stroke Paradoxical embolism Follow-up Prognosis
- 7.Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P, Chedru F, Guerin F, Bousser MG, de Recondo J (1993) Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography. Stroke 24:1865–1873PubMedCrossRefGoogle Scholar
- 10.Furlan AJ (2010) Closure I: a prospective, multicenter, randomized controlled trial to evaluate the safety and efficacy of the starflex® septal closure system versus best medical therapy in patients with a stroke or transient ischemic attack due to presumed paradoxical embolism through a patent foramen oval. In: Abstract at the Annual Meeting of the American Heart Association 2010Google Scholar
- 13.Feurer R, Sadikovic S, Sepp D, Esposito L, Schleef M, Bockelbrink A, Schwarze J, Hemmer B, Sander D, Poppert H (2010) Patent foramen ovale is not associated with an increased risk of stroke recurrence. Eur J Neurol 17(11):1339–1345Google Scholar
- 23.Fischer D, Haentjes J, Klein G, Schieffer B, Drexler H, Meyer GP, Schaefer A (2011) Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: Procedural and follow-up results after implantation of the Amplatzer®-occluder device. J Interv Cardiol 24:85–91PubMedCrossRefGoogle Scholar
- 24.Braun M, Gliech V, Boscheri A, Schoen S, Gahn G, Reichmann H, Haass M, Schraeder R, Strasser RH (2004) Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occluder systems. Eur Heart J 25:424–430PubMedCrossRefGoogle Scholar
- 25.Laufs U, Hoppe UC, Rosenkranz S, Kirchhof P, Böhm M, Diener HC, Endres M, Grond M, Hacke W, Meinertz T, Ringelstein EB, Röther J, Dichgans M (2010) Cardiological evaluation after cerebral ischaemia: consensus statement of the Working Group Heart and Brain of the German Cardiac Society-Cardiovascular Research (DGK) and the German Stroke Society (DSG). Clin Res Cardiol 99:609–625PubMedCrossRefGoogle Scholar