No major complications were reported from the 45 patients included in the study, leading physicians to determine that closure of patent foramen ovales (PFOs) and atrial septal defects (ASDs) with transcatheter devices is a safe surgical alternative for children and young adults who have had a stroke. Most patients who underwent device closure procedures for PFOs or ASDs remained symptom-free months afterward.
Published in the May issue of Mayo Clinic Proceedings, the retrospective medical record study involved patients from Mayo Clinic Rochester, the University of Parma in Italy, and Loyola University Medical Center in Illinois, who had been treated between January 1999 and August 2005. Included were patients younger than 35 who had undergone percutaneous closure (through the skin) of PFO or ASD and who had at least one presumed stroke.
Strokes in young patients are rare, but they present difficult clinical decisions when they occur, the study's authors say. Limited research exists on how young stroke patients fare from device closure procedures, prompting study authors to consider patient experiences from three medical centers.
The significance of PFOs in stroke patients has been confusing in part because previous studies have involved older patients and have overlooked the young, active population, says Donald Hagler, M.D., an author of Mayo's PFO study. Young stroke patients, as featured in the current study, often have large PFOs and are at greater risk for paradoxic embolization.
The study demonstrates further need for a large, prospective randomized trial with long-term follow-up to determine whether device closure is the best treatment for young stroke patients, its authors say. A randomized study is under way and may provide additional answers.
Authors for the study are Peter Bartz, M.D., and Allison Cabalka, M.D., from the Division of Pediatric Cardiology at Mayo Clinic; Frank Cetta, M.D., from the Divisions of Pediatric Cardiology and Cardiovascular Diseases at Mayo Clinic and formerly of Loyola University Medical Center; Donald Hagler, M.D., from the Divisions of Pediatric Cardiology and Cardiovascular Diseases at Mayo Clinic; Guy Reeder, M.D., from the Division of Cardiovascular Diseases at Mayo Clinic; Umberto Squarcia, M.D., Aldo Agnetti, M.D., Nicola Carano, M.D., and Bertrand Tachana, M.D., all from the University of Parma; and Enrico Aurier, M.D., from Parma Hospital.
Journal
Mayo Clinic Proceedings