Published Online
on July 29, 2004

A more recent version of this article appeared on September 1, 2004

This Article Full Text (PDF) All Versions of this Article: 35/9/2140    most recent 01.STR.0000137764.07815.dev1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Anzola, G. P. Articles by Onorato, E. Search for Related Content PubMed PubMed Citation Articles by Anzola, G. P. Articles by Onorato, E. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB NICKEL, ELEMENTAL Related Collections Other Stroke Treatment - Surgical Catheter-based coronary and valvular interventions: other Other diagnostic testing Embolic stroke Doppler ultrasound, Transcranial Doppler etc.

Submitted on March 31, 2004
Revised on May 31, 2004
Accepted on June 18, 2004

Does Transcatheter Closure of Patent Foramen Ovale Really "Shut the Door?". A Prospective Study With Transcranial Doppler

G. P. Anzola MD^*; E. Morandi MD; F. Casilli MD; and E. Onorato MD, FSCAI

From the Service of Neurology (G.P.A., E.M.), S. Orsola Hospital FBF, Brescia, Italy; and the Department of Cardiology (F.C., E.O.), Humanitas Gavazzeni Clinic, Bergamo, Italy.

^* To whom correspondence should be addressed. E-mail: gpanzola{at}numerica.it.

Background and Purpose--Transcatheter closure of patent foramen ovale (PFO) is increasingly being performed and monitored with transthoracic or transesophageal echocardiography, whereas contrast-enhanced transcranial Doppler (ce-TCD), which probably represents the most suitable tool to quantify right-to-left shunt (RLS) in the brain vessels, has been systematically overlooked. Our goal is to prospectively assess efficacy and safety of PFO transcatheter closure using ce-TCD.

Methods--A total of 140 consecutive patients (mean age, 46±13 years; male/female ratio, 63/77) with PFO-related large RLS and no other recognized cause of focal cerebral ischemia underwent transcatheter closure. TCD was done preoperatively and 1 month after the procedure in all patients, after 3 months in 120, after 6 months in 112, and after 1 year in 104 patients.

Results--Implantation was successful in all patients. During Valsalva strain, a large shunt was still detectable in 31 of 140 (22%), 15 of 120 (13%), 9 of 112 (8%), and 9 of 104 (9%) patients at the 1-, 3-, 6-, and 12-month visits, respectively. Periprocedural and postprocedural complications included atrial fibrillation in 8% and scintillating scotomata in 6% of patients. During the 1-year follow-up period, only 1 transient ischemic attack was recorded in a patient with paroxysmal atrial fibrillation and complete PFO closure.

Conclusions--Transcatheter PFO closure in patients with cryptogenic stroke and large RLS may be less successful than reported previously. TCD appears the ideal tool to follow up the closure process and to identify early, during follow-up, those patients who will be left with a significant shunt. Atrial fibrillation is more common than believed previously and may underlie the occurrence of further cerebrovascular events despite complete PFO closure. Irritative visual phenomena may occur as a consequence of nickel toxicity.

Key words: foramen ovale, patent • stroke

This article has been cited by other articles:

				N U Weir An update on cardioembolic stroke Postgrad. Med. J., March 1, 2008; 84(989): 133 - 142. [Abstract] [Full Text] [PDF]

				H. Sievert, E. Fischer, C. Heinisch, N. Majunke, A. Roemer, and N. Wunderlich Transcatheter Closure of Patent Foramen Ovale Without an Implant: Initial Clinical Experience Circulation, October 9, 2007; 116(15): 1701 - 1706. [Abstract] [Full Text] [PDF]

				E. Bedard, J. Rodes-Cabau, C. Houde, A. Mackey, D. Rivest, S. Cloutier, M. Noel, A. Marrero, J.-M. Cote, P. Chetaille, et al. Enhanced Thrombogenesis but Not Platelet Activation Is Associated With Transcatheter Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke Stroke, January 1, 2007; 38(1): 100 - 104. [Abstract] [Full Text] [PDF]

				G. P. Anzola, E. Onorato, F. Casilli, and E. Morandi Response to Letter by Gupta Stroke, September 1, 2006; 37(9): 2213 - 2213. [Full Text] [PDF]

				M. S. Albin, J. Wills, R. M. Schwend, S. Mazzucco, G. P. Anzola, J. R. Kizer, and R. B. Devereux Patent foramen ovale and unexplained stroke. N. Engl. J. Med., April 20, 2006; 354(16): 1753 - 1755. [Full Text] [PDF]

				H. W. Schuchlenz, G.P. Anzola, E. Morandi, F. Casilli, and E. Onorato Contrast Ultrasound Techniques in the Detection and Quantification of Patent Foramen Ovale: Myth Versus Reality * Response: Stroke, December 1, 2004; 35(12): 2755 - 2756. [Full Text] [PDF]