Recurrent cerebrovascular events in patients with a history of cryptogenic stroke or transient ischemic attack and patent foramen ovale in a long-term follow-up

Abstract

INTRODUCTION Cryptogenic stroke may be associated with a patent foramen ovale (PFO). Both car- diovascular risk factors and transcatheter closure of PFO may have an impact on the risk of recurrent cerebrovascular events. OBJECTIVES The aim of the study was to assess the occurrence and risk factors of recurrent cere- brovascular events (rCVE) in patients with a history of cryptogenic stroke or transient ischemic attack (TIA) and PFO. PATIENTs ANd METHODS Overall, 392 patients (median [interquartile range, IQR] age 39.5 [30–49] years, 64.3% women, 35.7% men) with a history of cryptogenic stroke / TIA and confirmed PFO underwent a long-term follow-up with a median (IQR) of 51.5 (35–65) months. The primary end point was defined as rCVE including stroke and TIA. REsuLTs During the follow-up, 17 patients with a history of cryptogenic stroke / TIA and confirmed PFO (4.3%, 11 women, 6 men) developed rCVE. In a multivariable analysis, the Risk of Paradoxical Embo- lism (RoPE) score was associated with a lower risk of rCVE (odds ratio [OR], 0.61 per 1 point; 95% CI, 0.45–0.84; P = 0.002). The transcatheter closure of PFO did not have a significant impact on rCVE in the study population (P = 0.19). CONCLUTIONS The occurrence of rCVE in the patients with cryptogenic stroke / TIA and PFO reached 4.3% regardless of a high percentage of patients who underwent the PFO closure. RoPE score was as- sociated with a lower risk of rCVE in the study population.