To dig oneself into a hole or to dig the tunnel to the core? A study on the Swartz sheath support strategy for patent foramen ovale closure in migraine patients

Objectives Patent foramen ovale (PFO) closure effectively alleviates symptoms in patients with migraines; however, multipurpose angiographic catheters often encounter difficulty in passing through a small shunt PFO. Here, we present a procedural approach for the treatment of small-shunt PFO and mid-term therapeutic outcomes. Methods Patients with migraine and concomitant PFO who visited our hospital between January 2020 and December 2022 were enrolled and grouped according to the application of the Swartz sheath support strategy (SSSS). Baseline characteristics, examination results, and surgical information were recorded. All patients were followed up for > 12 months, with the primary clinical endpoints being relief and cessation of migraine. Results A total of 285 patients were included, of whom 82 (28.8%) underwent the SSSS. No surgery-related complications were observed in the SSSS group. The relief ( P = 0.823) and cessation rates of headaches ( P = 0.742) were similar between the SSSS and non-SSSS groups. However, the absolute reduction in migraine burden was greater in the SSSS group ( P = 0.002). After propensity score overlap weighting, no significant differences in migraine outcomes were observed between the two groups. A stronger intensity of attacks (odds ratio [OR]: 4.52, 95% confidence interval [CI]: 1.33–15.30, P = 0.015) and medium-to-large degree residual shunt (OR: 4.52, 95% CI: 1.38–57.41, P = 0.020) were associated with migraine relief. Conclusions The SSSS is a safe and feasible technique for PFO closure in patients with migraine and difficult catheter passage, with postoperative improvement in migraine symptoms observed.