Cargando…

Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience

Introduction: The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. Methods: Between July 2009 and December 2019 at our University C...

Descripción completa

Detalles Bibliográficos
Autores principales: Evola, Salvatore, Camarda, Emmanuele Antonio, Triolo, Oreste Fabio, Adorno, Daniele, D’Agostino, Alessandro, Novo, Giuseppina, Onorato, Eustaquio Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10531865/
https://www.ncbi.nlm.nih.gov/pubmed/37762729
http://dx.doi.org/10.3390/jcm12185788
_version_ 1785111820675055616
author Evola, Salvatore
Camarda, Emmanuele Antonio
Triolo, Oreste Fabio
Adorno, Daniele
D’Agostino, Alessandro
Novo, Giuseppina
Onorato, Eustaquio Maria
author_facet Evola, Salvatore
Camarda, Emmanuele Antonio
Triolo, Oreste Fabio
Adorno, Daniele
D’Agostino, Alessandro
Novo, Giuseppina
Onorato, Eustaquio Maria
author_sort Evola, Salvatore
collection PubMed
description Introduction: The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. Methods: Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound–Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. Results: Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16–63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea–orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10–45 min) and the mean procedural time was 55 ± 20 min (range = 35–90 min). The total occlusion rate at follow-up (mean 50 months, range 3–100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. Conclusions: The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life.
format Online
Article
Text
id pubmed-10531865
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-105318652023-09-28 Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience Evola, Salvatore Camarda, Emmanuele Antonio Triolo, Oreste Fabio Adorno, Daniele D’Agostino, Alessandro Novo, Giuseppina Onorato, Eustaquio Maria J Clin Med Article Introduction: The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. Methods: Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound–Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. Results: Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16–63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea–orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10–45 min) and the mean procedural time was 55 ± 20 min (range = 35–90 min). The total occlusion rate at follow-up (mean 50 months, range 3–100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. Conclusions: The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life. MDPI 2023-09-05 /pmc/articles/PMC10531865/ /pubmed/37762729 http://dx.doi.org/10.3390/jcm12185788 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Evola, Salvatore
Camarda, Emmanuele Antonio
Triolo, Oreste Fabio
Adorno, Daniele
D’Agostino, Alessandro
Novo, Giuseppina
Onorato, Eustaquio Maria
Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience
title Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience
title_full Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience
title_fullStr Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience
title_full_unstemmed Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience
title_short Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience
title_sort clinical outcomes and quality of life after patent foramen ovale (pfo) closure in patients with stroke/transient ischemic attack of undetermined cause and other pfo-associated clinical conditions: a single-center experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10531865/
https://www.ncbi.nlm.nih.gov/pubmed/37762729
http://dx.doi.org/10.3390/jcm12185788
work_keys_str_mv AT evolasalvatore clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience
AT camardaemmanueleantonio clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience
AT trioloorestefabio clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience
AT adornodaniele clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience
AT dagostinoalessandro clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience
AT novogiuseppina clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience
AT onoratoeustaquiomaria clinicaloutcomesandqualityoflifeafterpatentforamenovalepfoclosureinpatientswithstroketransientischemicattackofundeterminedcauseandotherpfoassociatedclinicalconditionsasinglecenterexperience