Five Year Follow-Up of Cryptogenic Stroke Patients Following Pfo Closure

Background and Objectives: According to guidelines PFO closure is recommended for secondary stroke prevention in patients with cryptogenic stroke [1]. Paradoxial embolism from PFO mediated right to left shunt has been described as the mechanism of stroke in these cases [2]. The aim of the study is to follow-up patients after PFO closure and determine the long-term effectiveness on reccurent stroke risk reduction. Materials and Methods: A total of 103 patients were enrolled in a retrospective study and followed-up by phone up to five years after PFO closure. Standardized survey was conducted about their well-being, recurrent cerebrovascular events, and the use of prescribed medication. Patients were also followed up for residual shunts 24 h, 30 days, 1 and 2 years after PFO. The pathogenic ischemic stroke subtypes are determined using CCS (Causative Classification System for Ischemic Stroke). Results: 43.7% (n = 45) of patients were male. The mean age – 44.4 ± 13 (18–75). 53.4% (n = 55) of patients with possible cardio-aortic embolism the most probable cause for cryptogenic stroke was PFO. Residual shunts were mostly observed in patients with Amplatzer occluder – 87.5% (n = 14). There was correlation between residual shunt and increased risk of transient ischemic attack recurrence (p = 0.067). Five-years after PFO closure recurrent cerebrovascular events were reported in only 5.1% (n = 5) of patients, this difference is statistically relevant (p < 0.001). Out of 51 patient presented with complaints before PFO closure, 25.5% (n = 13) did not present with any complaints after PFO closure. Conclusions: PFO can be considered a possible risk factor for cryptogenic stroke. PFO closure is effective in reducing recurrent cerebrovascular events. Residual shunt after PFO closure increases the risk of transient ischemic attack recurrence. Amplatzer occluder device is associated with a higher risk for residual shunts after PFO closure. PFO closure can be associated with improvement of complaints.