Multidisciplinary Approach to Patent Foramen Ovale Closure for Cryptogenic Stroke: Brain-Heart Board Experience.

Background and Objectives

Patent foramen ovale (PFO) is present in approximately 25% of adult population. The prevalence of PFO is high in patients with cryptogenic stroke suggesting paradoxical embolism. PFO closure in carefully selected patients is an effective secondary preventive strategy in these patients. We report predictors of management recommendations by the multidisciplinary Board and their impact on outcomes.

Methods

Brain-Heart Board comprises vascular and interventional neurology and cardiology subspecialties (structural, electrophysiology, and cardiac imaging). Adult patients referred to the Board for consideration of PFO closure between October 2017 to March 2021 were included in this retrospective cohort analysis. Demographics, comorbid conditions, risk of paradoxical embolism (RoPE) score, event frequencies (transient ischemic attack [TIA] or stroke, intracranial hemorrhage [ICH], post-PFO closure cardiac arrhythmias), and modified Rankin Scale (mRS) at 1 year were compared between the groups (PFO closure vs medical management). Multivariable logistic regression was used to identify factors associated with management recommendation and chi-square tests to test differences in outcomes for patients according to management.

Results

Two hundred seventy patients (229 stroke; 41 TIA) were discussed by the Board for PFO closure. 119 (44.0%) patients were recommended for PFO closure of which 117 (98.3%) had evidence of ischemic infarct on imaging. In univariate analysis, age was similar (50 ± 11.9 vs 52 ± 12.8,

Discussion

Multidisciplinary Brain-Heart Board provides a clinical practice model of collaborative care to ensure proper patient selection for PFO closure. TIA as the index event is associated with recommendation of medical management by the multidisciplinary Brain-Heart Board.

Informations de copyright

© 2024 American Academy of Neurology.

Déclaration de conflit d'intérêts

M. Khan, P. Mccarthy, M. Miller, W. Merhi, N. Wees, N.I. Khan, A. Ahrar, E. Evans, M. Dahu, T. Moelker: No conflicts of interest relevant to the manuscript. J.P. Tsai: received compensation from Cerenovus and Microvention as a consultant. J. Min: received compensation from Abbott Laboratories and Medtronic as a consultant. Andre Gauri: received compensation from Medtronic as a consultant. N. Chalfoun: received compensation from Medtronic and Atricure as a consultant. D. Berkompas: received compensation from Medtronic and Abbott as a consultant. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.