Shin Yonghoon, Jang Albert Youngwoo, Won Yoonsun, Yang Taeil, Kim Joohan, Lee Joonpyo, Seo Jeongduk, Kim Minsu, Oh Pyung Chun, Chung Wook-Jin, Moon Jeonggeun, Kang Woong Chol
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
Front Cardiovasc Med. 2023 Oct 13;10:1249259. doi: 10.3389/fcvm.2023.1249259. eCollection 2023.
Patent foramen ovale (PFO) closure is performed in selected patients with cryptogenic stroke to prevent recurrence. The prognosis of patients with uncrossable PFO after failed guidewire or catheter passage during the procedure remains unknown. We compared the long-term prognosis between uncrossable PFO and successful PFO closure in patients with high-grade PFO shunts.
We analyzed patients who underwent PFO closure for stroke or transient ischemic attack (TIA) prevention at Gachon University Gil Medical Center between April 2010 and March 2022. The primary outcome was a composite of recurrent stroke or TIA. Secondary outcomes included stroke, TIA, all-cause death, and a composite of stroke, TIA, and all-cause death.
Of 286 patients, 245 were included in the analysis after excluding those with transseptal puncture technique usage or concurrent atrial septal defect. Among them, 82 had uncrossable PFO, and 163 underwent successful PFO closure. Large shunts were more prevalent in the PFO closure group compared to the uncrossable PFO group (62.0% vs. 34.1%, < 0.001), and resting shunts were also more common in the PFO closure group (17.8% vs. 2.4%, < 0.001). Stroke or TIA occurred in 2 patients (2.4%) in the uncrossable PFO group and 8 patients (4.9%) in the PFO closure group (hazard ratio, 1.44; 95% confidence interval, 0.30-6.81; = 0.647). Additionally, no disparities in the occurrence of stroke or TIA were found in subgroups divided by baseline characteristics, RoPE score, or shunt grade.
Clinical outcomes for patients with uncrossable PFO seem similar to those with successful PFO closure.
对于部分不明原因卒中患者，会进行卵圆孔未闭（PFO）封堵术以预防复发。在手术过程中，导丝或导管无法通过的PFO患者的预后尚不清楚。我们比较了高度PFO分流患者中无法通过的PFO与成功进行PFO封堵的长期预后。
我们分析了2010年4月至2022年3月期间在嘉泉大学吉尔医学中心因预防卒中或短暂性脑缺血发作（TIA）而接受PFO封堵术的患者。主要结局是复发性卒中或TIA的复合情况。次要结局包括卒中、TIA、全因死亡以及卒中、TIA和全因死亡的复合情况。
在286例患者中，排除使用经房间隔穿刺技术或合并房间隔缺损的患者后，245例纳入分析。其中，82例PFO无法通过，163例成功进行了PFO封堵。与无法通过的PFO组相比，PFO封堵组中大量分流更为普遍（62.0%对34.1%，<0.001），静息分流在PFO封堵组中也更常见（17.8%对2.4%，<0.001）。无法通过的PFO组中有2例患者（2.4%）发生卒中或TIA，PFO封堵组中有8例患者（4.9%）发生（风险比，1.44；95%置信区间，0.30 - 6.81；P = 0.647）。此外，在按基线特征、RoPE评分或分流等级划分的亚组中，未发现卒中或TIA发生率存在差异。
无法通过的PFO患者的临床结局似乎与成功进行PFO封堵的患者相似。
