Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure

• DOI: 10.1001/jamaneurol.2022.3248
• Publication Date: 2022-10-10T15:24:07Z
• Authors: Jean-Louis Mas; Jeffrey L. Saver; Scott E. Kasner; Jason Nelson; John D. Carroll; Gilles Chatellier; Geneviève Derumeaux; Anthony J. Furlan; Howard C. Herrmann; Peter Jüni; Jong S. Kim; Benjamin Koethe; Pil Hyung Lee; Benedicte Lefebvre; Heinrich P. Mattle; Bernhard Meier; Mark Reisman; Richard W. Smalling; Lars Sondergaard; Jae-Kwan Song; David E. Thaler; David M. Kent
• Keywords: Stroke

The Patent Foramen Ovale (PFO)-Associated Stroke Causal Likelihood classification system combines information regarding noncardiac patient features (vascular risk factors, infarct topography) and PFO (shunt size presence of atrial septal aneurysm [ASA]) to classify patients into 3 validated categories responsiveness treatment with closure. However, the distinctive associations shunt ASA, alone in combination, have not been completely delineated.To evaluate association closure stroke recurrence according and/or an ASA.Pooled individual data from 6 randomized clinical trials conducted February 2000 October 2017 that compared medical therapy. Patients North America, Europe, Australia, Brazil, South Korea PFO-associated were included. Analysis was completed January 2022.Transcatheter plus antithrombotic therapy vs alone, stratified 4 groups based on combination 2 features: small large or absence ASA.Recurrent ischemic stroke.A total 121 recurrent strokes occurred pooled 3740 (mean [SD] age, 45 [10] years; 1682 [45%] female) during a median (IQR) follow-up 57 (23.7-63.8) months. Treatment associated reduced for (adjusted hazard ratio [aHR], 0.41 [95% CI, 0.28-0.60]; P < .001). reduction greater both ASA (aHR, 0.15 0.06-0.35]) than without 0.27 0.14-0.56]), 0.36 0.17-0.78]), 0.68 0.41-1.13]) (interaction = .02). At years, absolute (5.5% 2.7-8.3]) other (1.0% all).Patients showed substantially beneficial neither nor ASA. These findings, combined features, may inform shared patient-clinician decision-making.