Clinical Analysis Of Closure Of Patent Foramen Ovale And Medical Therapy For Cryptogenic Stroke Combined With Patent Foramen Ovale

Background: The incidence of stroke is significantly higher in patients with patent foramen ovale(PFO),which suggests that PFO may be one of the risk factors for cryptogenic stroke.However,whether medical therapy or closure is more effective to prevent the recurrence of cryptogenic stroke remains unclear.Object: The purpose of this article is to compare the safety and efficacy of closure or medical therapy in cryptogenic stroke patients with PFO.Method: A retrospective analysis was performed between January 2011 to May 2016.The cryptogenic stroke patients with PFO who under the age of 60 were divided into two groups according to the therapy method during hospitalization: PFO closure group and medical therapy group.To investigate the efficacy and safety of treatment strategies for patients in both groups,we conducted a follow-up and statistical analysis of the recurrence of cerebral infarction and transient ischemic attacks(TIA)and the incidence of clinical complications resulting from treatment regimensResult: Of the 204 patients,80 were received medical therapy and 124 were accepted a device closure of PFO.All patients were followed for a median of 3 years.A total of 13 patients had primary endpoint events,including 9 patients in the medical therapy group(5 patients had TIA,3 patients had ischemic stroke,and 1 patient died).4 patients in the PFO closure group(3 had TIA and 1 had ischemic stroke).No adverse events were occurred in both groups.Compared to the medical group(11.25%),the cumulative incidence of all-cause mortality,stroke or transient ischemic attacks(TIAs)in the closure group was 3.22%(hazard ratio 0.289,95% confidence interval [CI],0.087 to 0.965,P=0.028).The incidence of recurrent stroke or TIA was also 10% vs.3.22%(medical group vs.closure group,hazard ratio 0.291,95% CI,0.085 to 0.991,P=0.046).Conclusion: During a long-term follow-up of patients who had a cryptogenic ischemic stroke with PFO,closure is associated with a lower recurrence of ischemic events,moreover PFO closure may be of more preventive significance for young patients with a severe right to left shunt.