Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Cardiology Institute, Sorbonne University, Pitié-Salpetrière (AP-HP) University Hospital, Paris, France.
Am J Cardiol. 2023 Jan 15;187:148-153. doi: 10.1016/j.amjcard.2022.10.044. Epub 2022 Nov 29.
Limited data exist on patients with a transient ischemic attack (TIA) who underwent patent foramen ovale (PFO) closure. The objectives of this study were to determine the clinical and procedural characteristics and long-term outcomes of patients with TIA who underwent transcatheter PFO closure. This was a multicenter study including 1,012 consecutive patients who underwent PFO closure after a cerebrovascular event. Patients were divided into 2 groups according to their index event leading to PFO closure: TIA (n = 183 [18%]), and stroke (n = 829 [82%]). The median follow-up was 3 (2 to 8) years (complete in 98% of patients). There were no significant differences between patients with TIA and stroke, except for a lower Risk of Paradoxical Embolism score in the TIA group (6.1 vs 6.9 in the stroke group, p <0.001). PFO closure was successful in all patients with a low rate of complications (<1%) in both groups. There were no differences in the incidence of neurologic events during long-term follow-up. There was 1 stroke event in the TIA group and 6 in the stroke group (0.08 vs 0.17 per 100 patients-years, p = 0.584). There were 2 TIA events in the TIA group and 10 in the stroke group (0.17 vs 0.28 per 100 patients-years, p = 0.557). In conclusion, our study showed that patients with TIA who underwent PFO closure have similar clinical characteristics as patients with stroke including a high Risk of Paradoxical Embolism score. Furthermore, these results suggest that PFO closure procedural results and long-term clinical outcomes are similar to their stroke counterparts, with a very low incidence of recurrent neurologic events. Further prospective randomized clinical trials are needed on this population.
关于接受卵圆孔未闭（PFO）封堵术的短暂性脑缺血发作（TIA）患者，相关数据有限。本研究旨在确定因脑血管事件而接受经导管 PFO 封堵术的 TIA 患者的临床和手术特征及长期结局。这是一项多中心研究，共纳入 1012 例因脑血管事件而接受 PFO 封堵术的连续患者。根据导致 PFO 封堵术的首发事件，将患者分为两组：TIA（n=183[18%]）和卒 中（n=829[82%]）。中位随访时间为 3（2 至 8）年（98%的患者完成随访）。TIA 组与卒中组患者之间除了 TIA 组的反常栓塞风险评分较低（6.1 比卒中组的 6.9，p<0.001）外，其他无显著差异。两组患者的 PFO 封堵均成功，并发症发生率均<1%。在长期随访期间，两组患者的神经事件发生率无差异。TIA 组发生 1 例卒中和 6 例卒 中（0.08 比 0.17 每 100 患者-年，p=0.584）。TIA 组发生 2 例 TIA 和 10 例卒 中（0.17 比 0.28 每 100 患者-年，p=0.557）。综上，本研究表明，接受 PFO 封堵术的 TIA 患者与卒中患者具有相似的临床特征，包括高反常栓塞风险评分。此外，这些结果提示 PFO 封堵术的手术结果和长期临床结局与卒中患者相似，且复发性神经事件发生率非常低。该人群需要进一步开展前瞻性随机临床试验。
