| Abstract [eng] |
Aim. To analyse data on secondary stroke prevention for patients with patent foramen ovale in Vilnius University Hospital Santaros klinikos. Methods. A retrospective study was performed, including patients aged 18-60 years, with a history of stroke and/or transient ischaemic attack and patent foramen ovale from September 20th, 2011 until December 31st, 2023. Demographic and logistic data, medical history, instrumental investigation results, and treatment were evaluated. Patient RoPE (Risk of Paradoxical Embolism) score and PASCAL (PFO-associated Stroke Causal Likelihood Classification System) category were assessed. Results. 210 patients were included in the study, of whom 55.2% were women, and the mean age was 39.7 (±8.85) years. 78 (37.1%) patients underwent percutaneous patent foramen ovale closure, while 132 (62.9%) were treated by medical therapy only (76,5% of them were prescribed antiplatelet drugs). Patients in the intervention group compared to the medical therapy group were younger (37.17 ±8,99 years versus 41.24 ±8.42 years, p=0.001), less often diagnosed with thrombophilia (7.7% versus 18.3%, p=0.037), had more recurrent ischaemic cerebrovascular events (15.4% versus 6.1%, p=0.026), more frequently had a large shunt at rest (46.1% versus 25.6%, p=0.001) and after the Valsalva manoeuvre (96.0% versus 68.3%, p=0.0001), more frequently had a RoPE score ≥7 (48.7% versus 31.8%, p=0.015) and more commonly had a probable embolization according to PASCAL classification (46.2% versus 28.0%, p=0.008). The median number of days from contrast-enhanced transcranial Doppler ultrasound to closure was 216.0 (IQR=164.5). Shunt closure was successful in 92.3% of cases, 7.7% of patients had documented cardiac arrhythmias after the intervention. Conclusions. One-third of the patients with patent foramen ovale underwent closure. In the medical therapy group, antiplatelet drugs were most commonly prescribed for antithrombotic treatment. The intervention group patients more frequently had a large shunt, higher risk of embolism and greater probability that the stroke was due to paradoxical embolization. Shunt closure was effective and safe. |
