Abstract
Background
Recent randomized trials have confirmed the role of patent foramen ovale (PFO) closure
in the secondary prevention of cryptogenic stroke. Guidelines have suggested a central
role for intraprocedural imaging using intracardiac echocardiography (ICE). However,
this modality may not be required to achieve safe and effective closure. We aimed
to examine the periprocedural outcomes of PFO closure retrospectively, using fluoroscopic
guidance in patients with cryptogenic stroke, with provisional ICE guidance driven
by anatomic and procedural factors.
Methods
A retrospective chart review of consecutive patients who underwent PFO closure in
a single centre using the Amplatzer PFO occluder (AGA Medical Corporation, Plymouth,
Minnesota) for cryptogenic stroke was conducted. Outcomes analyzed included procedural
data, periprocedural complications, length of stay, and factors contributing to the
use of intraprocedural imaging.
Results
Between 2006 and 2017, 467 patients underwent PFO closure for cryptogenic stroke with
the Amplatzer PFO occluder; 381 patients underwent closure with fluoroscopy alone,
and 86 with ICE and fluoroscopic guidance. Periprocedural arrhythmic complications
occurred in 1.3% in the fluoroscopy group and 1.2% in the ICE group (P = 1.000). Vascular complications occurred in 0.5% in the fluoroscopy group and 2.3%
(P = 0.323) in the ICE group. One device embolized requiring surgical intervention.
There was no in-hospital mortality or stroke. Same-day discharge occurred in 97.6%
of patients.
Conclusion
Our single-centre experience suggests that PFO closure can be safely conducted under
fluoroscopic guidance alone with provisional adjunctive ICE use limited to specific
anatomic situations.
Résumé
Introduction
De récents essais à répartition aléatoire ont confirmé le rôle de la fermeture du
foramen ovale perméable (FOP) dans la prévention secondaire de l’accident vasculaire
cérébral (AVC) d’origine cryptogénique. Les lignes directrices ont montré le rôle
central de l’imagerie intraprocédurale au moyen de l’échocardiographie intracardiaque
(EIC). Toutefois, cette modalité ne devrait pas être nécessaire pour obtenir une fermeture
sûre et efficace. Nous avions pour objectif d’examiner rétrospectivement les résultats
périprocéduraux de la fermeture du FOP sous guidage fluoroscopique chez les patients
ayant subi un AVC d’origine cryptogénique, et sous guidage provisoire de l’EIC motivé
par les facteurs anatomiques et procéduraux.
Méthodes
Nous avons réalisé une revue rétrospective des dossiers de patients consécutifs d’un
seul centre qui subissaient une fermeture du FOP au moyen de l’obturateur de FOP Amplatzer
(AGA Medical Corporation, Plymouth, Minnesota) en raison d’un AVC d’origine cryptogénique.
Parmi les résultats analysés, on trouvait les données procédurales, les complications
périprocédurales, la durée du séjour et les facteurs contribuant à l’utilisation de
l’imagerie intraprocédurale.
Résultats
Entre 2006 et 2017, 467 patients ont subi une fermeture du FOP en raison d’un AVC
d’origine cryptogénique au moyen de l’obturateur de FOP Amplatzer; 381 patients ont
subi une fermeture par fluoroscopie seule et 86 par EIC et guidage fluoroscopique.
Des complications arythmiques périprocédurales sont survenues chez 1,3 % dans le groupe
de la fluoroscopie et chez 1,2 % dans le groupe de l’EIC (P = 1,000). Des complications
vasculaires sont survenues chez 0,5 % dans le groupe de la fluoroscopie et chez 2,3
% (P = 0,323) dans le groupe de l’EIC. Un dispositif embolisé nécessitant l’intervention
chirurgicale. Il n’y a eu ni mortalité intra-hospitalière ni AVC. La sortie de l'hôpital
le jour même a eu lieu chez 97,6 % des patients.
Conclusion
Notre expérience dans un seul centre suggère que la fermeture du FOP peut être réalisée
de manière sécuritaire sous guidage fluoroscopique seul et l’utilisation provisoire
de l’EIC d’appoint restreinte à des situations anatomiques particulières.
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Article info
Publication history
Published online: January 13, 2020
Accepted:
December 26,
2019
Received:
October 14,
2019
Footnotes
See editorial by Mathew and Taylor, pages 1569—1571 of this issue.
See page 1614 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Fluoroscopy-Only Guided Patent Foramen Ovale Device Closure: Will It Cut Ice With the Interventionalist Community?Canadian Journal of CardiologyVol. 36Issue 10
- PreviewOne-third of all ischemic strokes are of unknown cause.1 Patent foramen ovale (PFO) closure, for the prevention of stroke recurrence in patients with cryptogenic stroke (CS), has evolved from a putative therapy to one grounded in clinical trial evidence.1 Earlier “negative” trials comparing the efficacy of PFO closure with medical therapy for preventing stroke recurrence had limitations. Those trials used older-generation devices,2 had lower-than-expected event rates, or included patients with a transient ischemic attack as the index event.
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