CAN TRANSCATHETER OCCLUSION OF A PERSISTE NT FORAMEN OVALE PREVENT PARADOXICAL EMBOLISM

Background and objective: Cerebral embolism may have different causes with sometimes serious consequences. If no specific reason can be foun d, paradoxical embolization through a persistent foramen ovate (PFO) i s increasingly as a cause of the cerebral ischaemia. This study was un dertaken to ascertain whether in patients with cerebral embolism occlu sion of a PFO with a transcatheter technique can prevent further cereb ral emboli. Patients and methods: Indications for transcatheter occlus ion were based on neurological signs (ischaemic stroke), cardiovascula r diagnosis, and coagulation tests. Between August 1991 and July 1996, transcatheter occlusion of a PFO was performed in 28 fully anticoagul ated patients (median age 37.8 [15.4-65.4] years). The mean PFO diamet er was 9.5 mm (3-17), mean duration of fluoroscopy 18.3 (8.7-43.1) min . The Rashkind device was implanted in three patients, the Sideris but toned device in 25. During the follow-up period (2-64 months; mean 13 months) renewed neurological symptoms occurred in only one patient. Tr ansoesophageal echocardiography excluded thrombi on the implanted devi ce or in the left atrium, and a residual PFO. The cause of the one neu rological episode is therefore not clear. All other patients have rema ined free of symptoms and recurrence without anticoagulation after pla cement of the device. Conclusions: Transcatheter occlusion of a PFO is a relatively simple and safe procedure. Our results suggest that it c an at least lower the incidence of further cerebral embolizations. The clinical value of the method in comparison with anticoagulation requi res further study.