Residual shunt after patent foramen ovale closure linked to higher risk for stroke

The presence of a residual shunt after patent foramen ovale (PFO) closure is associated with an increased risk for recurrent stroke or transient ischemic attack (TIA), according to a study published online May 12 in the Annals of Internal Medicine.

Wenjun Deng, Ph.D., from Massachusetts General Hospital in Boston, and colleagues examined the long-term association of a residual shunt with recurrent neurologic events after percutaneous PFO closure. A total of 1,078 patients with PFO-attributable cryptogenic stroke undergoing percutaneous PFO closure were followed for up to 11 years.

The researchers found that the presence of a residual shunt versus complete closure was associated with an increased incidence of recurrent stroke or TIA (2.32 versus 0.75 events per 100 patient-years; hazard ratio, 3.05; 95 percent confidence interval, 1.65 to 5.62; P < 0.001). After adjustment for covariates, including age; study period; device; presence of atrial septal aneurysm, hypertension, hyperlipidemia, diabetes, hypercoagulability, or hypermobile septum; and medication use, the results remained robust (hazard ratio, 3.01; 95 percent confidence interval, 1.59 to 5.69; P < 0.001). Moderate or large residual shunts were associated with an increased risk for stroke or TIA recurrence (hazard ratio, 4.50; 95 percent confidence interval, 2.20 to 9.20; P < 0.001), while the result was not statistically significant for small residual shunts (hazard ratio, 2.02; 95 percent confidence interval, 0.87 to 4.69; P = 0.102).

"We suggest that patients with a moderate or large residual shunt be followed long term with multidisciplinary care," the authors write.

One author disclosed financial ties to the pharmaceutical and medical device industries.

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