Long-term follow-up after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism in elderly patients (≥ 70 years) - 06/02/12
Abstract |
Purpose |
Patent foramen ovale (PFO) has been associated with cryptogenic stroke both in younger and older patients. Although percutaneous PFO closure has been shown safe and effective in patients >55years old, the long-term outcome of elderly patients (≥70 years) has not specifically been reported.
Patients and methods |
Between November 1998 and October 2008, 839 consecutive patients (age 52±13 years; 60% male) underwent percutaneous PFO closure for secondary prevention of paradoxical embolism (94% cerebral, 6% peripheral) using the Amplatzer PFO Occluder under fluoroscopic guidance only. Among them, 58 patients (7%) ≥70years old were included in the present study.
Results |
The implantation procedure was successful in all patients. There were no procedural complications. Transesophageal echocardiography at 6 months, performed in 49 patients (84%), showed complete occlusion in 45 patients (92%), and a residual shunt in four patients (8%). During a mean follow-up of 5.2±2.4years (median 5.0; total 290 patient-years) three ischaemic strokes (two of them fatal) and five transient ischaemic attacks occurred. Freedom from recurrent ischaemic stroke, transient ischaemic attack, or peripheral embolism was 100% at 1 year, 86% at 5 years, and 82% at 10 years. The risk of recurrent thromboembolic events was significantly higher as compared to the patients<70years old (P<0.001).
Conclusions |
This study confirms the safety, feasibility, and clinical efficacy of percutaneous PFO closure guided by fluoroscopy only in elderly patients. Percutaneous PFO closure should be considered a therapeutic option in all patients with suspected paradoxical embolism, including the elderly.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial septal aneurysm, Patent foramen ovale, Embolism, Secondary stroke prevention, Elderly
Plan
Vol 3 - N° 1
P. 23-27 - février 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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