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Residual Shunt After PFO Closure Linked to Higher Risk for Stroke

Risk for recurrent stroke, transient ischemic attack increased with presence of residual shunt

heart model

MONDAY, May 11, 2020 (HealthDay News) -- The presence of a residual shunt after patent foramen ovale (PFO) closure is associated with an increased risk for recurrent stroke or transient ischemic attack (TIA), according to a study published online May 12 in the Annals of Internal Medicine.

Wenjun Deng, Ph.D., from Massachusetts General Hospital in Boston, and colleagues examined the long-term association of a residual shunt with recurrent neurologic events after percutaneous PFO closure. A total of 1,078 patients with PFO-attributable cryptogenic stroke undergoing percutaneous PFO closure were followed for up to 11 years.

The researchers found that the presence of a residual shunt versus complete closure was associated with an increased incidence of recurrent stroke or TIA (2.32 versus 0.75 events per 100 patient-years; hazard ratio, 3.05; 95 percent confidence interval, 1.65 to 5.62; P < 0.001). After adjustment for covariates, including age; study period; device; presence of atrial septal aneurysm, hypertension, hyperlipidemia, diabetes, hypercoagulability, or hypermobile septum; and medication use, the results remained robust (hazard ratio, 3.01; 95 percent confidence interval, 1.59 to 5.69; P < 0.001). Moderate or large residual shunts were associated with an increased risk for stroke or TIA recurrence (hazard ratio, 4.50; 95 percent confidence interval, 2.20 to 9.20; P < 0.001), while the result was not statistically significant for small residual shunts (hazard ratio, 2.02; 95 percent confidence interval, 0.87 to 4.69; P = 0.102).

"We suggest that patients with a moderate or large residual shunt be followed long term with multidisciplinary care," the authors write.

One author disclosed financial ties to the pharmaceutical and medical device industries.

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