2023 American Academy of Neurology Abstract Website

Muhib Khan¹, Philip McCarthy³, Diana Haggerty², Jiangyong Min⁴, Malgorzata Miller³, Jenny Tsai⁵, William Merhi³, Duane Berkompas³, Nabil Wees³, Nadeem Khan³, Asad Ahrar³, Elizabeth Evans⁶, Musa Dahu³, Andre Gauri³, Tarah Moelker³, Nagib Chalfoun³
¹Neuroscience Institute, Michigan State University, ²Michigan State University, ³Spectrum Health, ⁴Spectrum Health Neuroscience, ⁵Spectrum Health West Michigan, ⁶Spectrum Health Medical Group

Objective:

Our study evaluates the predictors of closure recommendation by multidisciplinary board for PFO closure and its impact on outcomes.

Background:

PFO closure in carefully selected patients is an effective secondary preventive strategy in young cryptogenic stroke patients which requires close collaborative approach.

Design/Methods:

Brain-Heart Board is comprised of vascular neurology and cardiology subspecialities. Adult patients referred to the board for consideration of PFO closure between October 2017 to March 2021 were included in this analysis. Demographics, comorbid conditions, infarct location, Risk of Paradoxical Embolism (RoPE) Score, event frequencies (recurrent TIA or stroke, intracranial hemorrhage (ICH), post-PFO closure cardiac arrythmias) and modified Rankin Scale (mRS at 1 year) were compared between the groups (PFO closure vs. medical management). Multivariable logistic regression was used to identify predictors of closure and chi-square tests to test differences in outcomes for patients according to management.

Results:

270 patients (229 stroke; 41 TIA) were included in the analysis. 119 (44%) patients were recommended for PFO closure of which 117 (98%) had infarct on neuroimaging. Age and RoPE score were similar in closure and medical management cohorts (age; 50±12 vs. 52±13, p>0.05 RoPE 4±3 vs. 6±2 p>0.05). In multivariable analysis, absence of infarct on neuroimaging was an independent predictor of medical management recommendation by the board (OR 0.05 95% CI 0.01-0.19 p<0.05). Event frequency was low in both cohorts (5.9% vs. 4.8% p>0.05) and were comprised primarily of cardiac arrhythmias (6 atrial fibrillation and 1 ICH in Closure group; 1 TIA and 1 recurrent stroke in medical management group). Excellent functional outcome (mRS 0-1) was similar in both cohorts (66% vs. 71% p>0.05) at 1 year.

Conclusions:

Multidisciplinary approach towards PFO closure results in low frequency of complications (recurrent ischemic stroke, ICH and post-PFO closure cardiac arrythmias) and good outcomes. Infarct on neuroimaging predicts closure recommendation by the multidisciplinary board.