{
  "abstract": "Introduction Patent foramen ovale (PFO) closure is an established intervention for secondary prevention of stroke in carefully selected patients. We analysed the success rates, complication rates and short-term clinical outcomes of PFO closures performed in a district general hospital with integrated stroke and cardiology services.Methods We performed a retrospective analysis of 27 consecutive PFO closures for secondary prevention of cryptogenic stroke or TIA between December 2023 and December 2020. Patient demographics, risk factors, ROPE score, procedural details and follow up outcomes were extracted from electronic records. Continuous variables are reported as mean ± standard deviation or median and inter quartile range (IQR), categorical variables are reported as counts and percentages.Results A total of 27 patients underwent PFO closure after selection at MDT. There was a mean age 52.0 ± 8.6 years, 20 (74.1%) were male, and there was a mean BMI of 26.0 ± 4.5 kg/m 2. The most common comorbidities were dyslipidaemia (N= 15, 55.6%), hypertension (N=7, 20.9%), thrombophilia (N=3, 11.1%), history of venous thromboembolism (N=3, 11.1%) and migraine (N = 2, 7.4%). Nine (33.3%) subjects were current or ex-smokers, and no subjects had documented diabetes or atrial fibrillation prior to the index event. There were 23 (85.2%) patients diagnosed with stroke and 4 (14.8%) with TIA. 26 (96.3%) index events were considered cryptogenic and there was a median ROPE score of 7 (IQR: 6–7). Among stroke patients, median NIHSS was 2 (IQR: 1–4.20) and all had mRS 0 at discharge. All patients had an MRI brain, TTE, and TOE. Holter monitoring was performed in 26 (96.3%) and CTA intracranial in 21 (77.8%). Median time from index event to closure was 10.8 months (IQR: 5.7–16.5 months). Procedural success was achieved in 26 (96.3%) patients, with 1 procedure abandoned without complication due to technical difficulties. Post procedure short term dual antiplatelet therapy (3–6 months) followed by lifelong single antiplatelet was given in 20 (96%) of patients, with one patient on short term clopidogrel and DOAC, followed by DOAC alone. One (3.7%) peri-procedural complication occurred due to device embolisation, however device implantation was ultimately successful, and the patient suffered no long-term consequences. During follow up (range 3–30 months) there were no recurrent strokes or TIAs. New onset atrial fibrillation was documented in one patient post procedure.Conclusions This real-world experience with PFO closure in a district hospital shows low procedural and follow up complications with no recurrent TIA or stroke events at short term follow up. These results are promising and are comparable with landmark trials, however, should be interpreted with caution due to the low numbers. Further follow up and larger studies are required to further assess the efficacy of PFO closure in this setting.",
  "authors": [
    {
      "affiliations": [
        "Wycombe Hospital Buckinghamshire Healthcare NHS Trust, Wycombe, United Kingdom"
      ],
      "name": "Robert Ambrogetti"
    },
    {
      "affiliations": [
        "Wycombe Hospital Buckinghamshire Healthcare NHS Trust, Wycombe, United Kingdom"
      ],
      "name": "Sina Fathieh"
    },
    {
      "affiliations": [
        "Wycombe Hospital Buckinghamshire Healthcare NHS Trust, Wycombe, United Kingdom"
      ],
      "name": "Alex Henshall"
    },
    {
      "affiliations": [
        "Wycombe Hospital Buckinghamshire Healthcare NHS Trust, Wycombe, United Kingdom"
      ],
      "name": "Zoe Ravalier"
    },
    {
      "affiliations": [
        "Wycombe Hospital Buckinghamshire Healthcare NHS Trust, Wycombe, United Kingdom"
      ],
      "name": "Rajaperumal Ravi"
    },
    {
      "affiliations": [
        "Wycombe Hospital Buckinghamshire Healthcare NHS Trust, Wycombe, United Kingdom"
      ],
      "name": "Rodney De Palma"
    }
  ],
  "title": "498 Outcomes of patent foramen ovale closure for secondary prevention of stroke in a district general hospital",
  "uid": "e571933b-43a2-5d5d-83d3-10afa3e88251"
}