PFO Closure in Young-older Patients with Cryptogenic Stroke

Background: Patent foramen ovale (PFO) closure is recommended for patients younger than 60 years with cryptogenic stroke, including embolic stroke of undetermined source (ESUS). However, the role of PFO closure in patients older than 60 years remains uncertain. We aim to investigate the benefits of PFO closure in young-older patients (aged between 60 and 70 years) with cryptogenic stroke. Methods: Patients older than 60 years with cryptogenic stroke from large tertiary hospitals who received a PFO closure after a multidisciplinary brain-heart case conference, compared to an age-matched cohort of patients with cryptogenic stroke. Demographcis, vascular risk factors, and risk of paradoxical embolism (RoPE) score were collected for comparison between two groups. The primary outcome included recurrent ischemic stroke that occurred up to 5 years following PFO closure between the two groups. The safety outcome was the occurrence of any complications after PFO closure, including new-onset atrial fibrillation (AF). Results: A total of 102 patients with cryptogenic stroke were included (mean age 66±4), 56 male (55%), who had a PFO closure. Procedure-related complications, including new onset transient AF, were low (1%). There was no statistical difference between two groups in patients demographic and clinical characteristics, but the RoPE score was significantly higher in the PFO closure group than in the control group. After a median follow-up of 54 months, patients in the PFO closure group demonstrated a relatively low incidence of recurrent ischemic stroke (3.9%, 4/102), compared to an age-matched control cohort with a median follow-up of 51 months, which had a higher recurrence rate (8.2%, 8/97). Conclusions: In patients with cryptogenic stroke who are older than 60 years, PFO closure demonstrated safety profiles with a trend of reducing recurrent ischemic stroke compared to their age-matched counterparts. Prospective randomized trials are warranted in this young-older population with cryptogenic stroke and PFO.