pfo closure

Hi Meg,

Thank you for starting a conversation about PFO and closure. We’ve had a few calls to StrokeLine about this over the years. The Stroke Foundation has recently released a draft Clinical Guidelines for Stroke Management 2017 for public consultation. The guidelines are based on an in depth review of high quality data across a number of related areas and includes PFO and closure. Review of the strongest level of data available (Randomised Controlled Trials – RCT) shows benefits for both and similar outcomes for closure versus medical treatment. Here are the guidelines on this:

STRONG RECOMMENDATION: Patients with ischaemic stroke or TIA and PFO should receive optimal medical therapy including antiplatelet therapy or anticoagulation if indicated (Homma et al 2002 [203]; Shariat et al 2013 [201])

WEAK RECOMMENDATION (AGAINST): Routine endovascular closure of patent foramen ovale is not recommended. Endovascular closure may be reasonable in highly selected young ischaemic stroke patients after thorough exclusion of other stroke aetiologies (Kent et al 2016 [204]; Li et al 2015 [199]; Stortecky et al 2015 [200]).

In young people with stroke there are generally a whole range of factors that are investigated, including the most common risk factors, blood disorders, cardiac causes such as PFO and more. It is a case by case situation. Generally yes, those with cardiac causes, including PFO are referred to a cardiologist. Not all stroke survivors will see a neurologist long term, again this is also case by case but many would in the acute phase to discuss management of the PFO.

In terms of being offered closure, again this varies and is also case by case. For peace of mind, many young stroke survivors will often decide to go ahead with closure. Decisions are made based on patient preference and individual risk. We’ve certainly had calls to StrokeLine where the stroke survivor has been offered closure by one or more specialists yet had opinions by other specialists who have advised against closure. It is definitely a case by case situation. I've heard of an 81 year old woman who recently had a closure after a recent stroke and diagnosis of PFO. As time goes on, hopefully more research will be completed and the evidence will become clearer to guide decision making.

I hope this helps. There are likely to be other survivors who I hope will comment on their personal experience of PFO and closure. If you would like to discuss further please call us on StrokeLine on 1800 787 653.

Best wishes,

Simone (Occupational Therapist for StrokeLine)

Hi Meg,

I had my cryptogenic stroke last year at 36 years old, and was routinely tested within 36 hours for a pfo.  I had the advice of neurologists, and a cardiologist whom my neurologist only referred me to at my insistence.  I had my pfo closure done in March this year, against my neurologist's recommendation, I'm not sure all the specialists will ever all agree on the data, or the treatment!  I'm happy I've had it done for my own peace of mind, and my fatigue has only started reducing since having it done. It's such a hard decision to make.  Good luck!

Cindy

Thanks Cindy for adding your personal experience to the conversation, it is so valuable. That is great news your fatigue has been reducing since the closure and it all went well.

Simone (StrokeLine)

My stroke and occluded carotid artery was caused by pnemonia, which then triggered atrial fibullation. I had no family history, blood pressure 110/70 , BMI 24, total cholesterol 4.8 & was very active.The echocardiogram detected a FPO. My cardiologist has now recommended against FPO surgery. I take anti coagulants and stains and recently was prescribed beta blockers, which I feel are an overkill as I suffer no detectable AF.

The new RESPCT study shows there is a benefit to closing PFOs than medical theory alone. This is especially true for patients who also have an ASA (Atrial Septal Aneurysm) the combination of PFO and ASA seems particularly dangerous. I had my PFO closure done overseas in Virginia USA  with something new called Noblestitch. It does not leave a device in the heart and therefore doesn't  have any of the device related risks like blood clots, infection or AFib! Changed my life! I'm sure the debate of whether to close PFOs will rage on, but for me it was the right decision. I know longer have to worry about having a stroke and as a bonus haven't had a single migraine aura since! 

Thanks for replying. That does sound like the stitch has many advantages. How did you go about accessing this treatment. In the US?

Hi Meg it took a lot of research but was in the end was fairly easy!  My advice is to join the NobleStitch support group on Facebook there is so much information there. There a  few doctors in Europe and one amazing doctor who does NobleStitch in the US - Dr James Thompson from Fairfax Virginia.  To say that is kind and caring is an understatement!  NobleStitch is still in clinical trials, but he can get you on it... and in over 1000 cases there has not been one complication and of course no risk of Nickle allergy!  All I did was call his office and set up Skype call and set him my medical records.  I'm happy to do an email introduction to him for you if you like. Please feel free to ask me any questions. I had a large PFO that was shunting at rest and an ASA as well.  I feel so relieved to have this stroke monkey off my back! As an added bonus my heart mumur and migraines have disappeared.