Kanon, Matthijs (2025) Stroke and Transient Ischemic Attack Recurrence after PFO Closure in Patients with Cryptogenic Embolism. thesis, Medicine.
Full text available on request.Abstract
Introduction: Current guidelines recommend patent foramen ovale (PFO) closure in selected patients with cryptogenic stroke and a PFO. A few randomized controlled trials (RCTs) have shown superiority of PFO closure over medical therapy in reducing recurrent stroke risk. However, follow-up data outside clinical trials remains scarce. The aim of this study is to evaluate the stroke/transient ischemic attack (TIA) recurrence after PFO closure. Methods: Data from 242 patients who underwent PFO closure at the University Medical Centre Groningen between February 2016 and June 2023, because of a cryptogenic stroke, TIA or peripheral embolism, were collected. Results: During a median follow-up of 3.1 years (IQR: 1.9-4.3), a total of 5 strokes (0.70 per 100 person-years) and 11 TIAs (1.54 per 100 person-years) were documented. In patients with a recurrent neurological event, hypertension was more prevalent (30.8% vs. 9.6%, p = 0.040). No differences in stroke/TIA recurrence were seen between patients who discontinued antithrombotic medication during follow-up and those who were still on medication. Atrial fibrillation (AF) or atrial flutter was seen in 5.7% of the patients. Other adverse events were rare. Conclusion: In this study, the rate of recurrent stroke/TIA after PFO closure was low, but higher than reported in previous studies. These elevated values are primarily due to the higher risk of recurrent TIA, as the recurrent stroke risk in our cohort is comparable to that reported in RCTs. Hypertension was significantly associated with the recurrence of a stroke/TIA. Discontinuing antithrombotic therapy after several months or years may be a safe option after PFO closure, but future RCTs are needed to proof this hypothesis.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Wijngaarden, dr. J. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Mar 2026 13:45 |
| Last Modified: | 24 Mar 2026 13:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3909 |
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