2024 American Academy of Neurology Abstract Website

Objective:

We aim to investigate the benefit of patent foramen ovale (PFO) closure in older patients with embolic stroke of undetermined source (ESUS). Patients were carefully selected after an evaluation by a group of neurologists and cardiologists.

Background:

PFO closure is recommended for patients younger than 60 years with ESUS. However, the role of PFO closure in patients older than 60 years is unclear.

Design/Methods:

This single-center observational study recruited patients older than 60 years with ESUS, who had a PFO closure following presumed PFO-related ischemic stroke. The primary outcome was a composite of recurrent ischemic stroke, transient ischemic attack, or fatal stroke that occurred up to 5 years following PFO closure. The safety outcome was the occurrence of any complications after a PFO closure, including new-onset atrial fibrillation (AF).

Results:

A total of 64 patients were included (mean age 65.4±5.2), 39 of which were male (61.9%). Mean RoPE score was 4. Procedure-related complications, including new onset AF were low (1.6%). After a median follow-up of 2.4 years, patients older than 60 years demonstrated a high incidence of recurrent ischemic stroke (6.3%, 4/64), recurrent transient ischemic attack (3.1%, 2/64), but no recurrent fatal stroke (0%, 0/64) as their younger (age<60) counterparts (1.5% overall recurrent cerebrovascular events from 6 clinical trials). However, there was an overall 98.3% freedom from a recurrent stroke following PFO closure (95% CI: 88.4%, 99.8%) in this older population with ESUS.

Conclusions:

In patients with cryptogenic stroke who are older than 60 years, PFO closure demonstrated similar safety profiles but was associated with a relatively high risk of recurrent ischemic stroke compared to their younger counterparts reported in previous 6 trials (CLOSE, CLOSURE-I, DEFENCE-PFO, REDUCE, RESPECT and PC Trial). Randomized trials compared to same-age patients are warranted in this population.