Неврология, нейропсихиатрия, психосоматика (Dec 2020)

Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

  • D. V. Ognerubov,
  • A. S. Tereshchenko,
  • A. N. Samko,
  • G. К. Arutyunyan,
  • O. A. Sivakova,
  • D. V. Pevzner,
  • M. I. Makeev,
  • T. V. Balakhonova,
  • A. V. Belopasova,
  • M. Yu. Maksimova,
  • S. E. Chuprina,
  • E. P. Khodyakova,
  • A. A. Kulesh,
  • S. A. Mekhryakov,
  • D. Yu. Shchekochikhin,
  • A. A. Bogdanova,
  • E. V. Merkulov

DOI
https://doi.org/10.14412/2074-2711-2020-6-26-32
Journal volume & issue
Vol. 12, no. 6
pp. 26 – 32

Abstract

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Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

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