Comparison Of The Effectiveness Of Transcatheter Closure And Medical Therapy For Cryptogenic Stroke With Patent Foramen Ovale

Objective To compare the effect of patent foramen ovale closure and drug therapy in cryptogenic stroke patients with patent foramen ovale,providing a better treatment of secondary prevention in these patients.Methods A total of 121 patients with ischemic stroke and PFO enrolled from April,2016 to June 2018 in our hospital.According to the evaluation and patients' wishes,these patients were divided into transcatheter PFO closure group(closure group,n=59)and anticoagulation/ antiplatelet treatment group(medical group,n=62).Follow-up assessments were performed 3 months,6 months,12 months and 2 years,the effectiveness(recurrent ischemic stroke/TIA,death,and complete occlusion rate of the foramen ovale)and safety(surgical-related complications,bleeding,etc.)of treatment were compared between the two groups.Results There were no differences in baseline clinical characteristics between the two groups.Within 2 years after treatment,there was no recurrent stroke/TIA in the closure group,1 case died.In the medical group,the recurrence rate was 9.7%,no death occurred.There was statistically significant difference in recurrence rate between the two groups(P=0.03).Paroxysmal atrial fibrillation occurred in one patient after closure and converted spontaneously to sinus rhythm;residual shunt were founded in 4 patients with TCD test(3 of them are massive shunt and one of small shunt),One of them had small residual shunt after 6 months of follow-up.There were no complications related to surgery and serious bleeding in the two groups.Among them,there were 19 older patients(aged >60 years)in closure group and 25 patients in medical group.The recurrence rate was 0 and 12% separately,the difference was not statistically significant between the two groups(P=0.25).And there were no closure-related adverse events and severe bleeding events in older patients.Conclusion Transcatheter PFO closure was beneficial for preventing stroke recurrence in the patients with cryptogenic stroke and PFO,while in older patients,transcatheter closure treatment and medical treatment are equally effective.