DEFENSE-PFO: High Risk PFO Closure Reduces Combined Events and Stroke Risk

High risk patent foramen ovale closure PFO resulted in reduced stroke, vascular death and bleeding risk.

DEFENSE-PFO: el cierre FOP con ciertas características disminuye eventos combinados y strokeRecent reports have shown a favorable role of PFO in patients with cryptogenic stroke, though with some unclear results, which immediately raised the questions: Who are the optimal candidates for this procedure, and who will see no benefit?

 

This study focused on certain characteristics of PFO assessed by transesophageal ECG that could be risk predictors and tilt the scales for transcatheter PFO closure.


Read also: Stroke, Migraine and Patent Foramen Ovale Not Necessarily Temporary Associated.


The study included patients with cryptogenic stroke and high risk characteristics such as atrial septal aneurysm, septal hypermobility (phasic septal excursion into either atrium ≥10 mm), and PFO size (maximum separation of the septum primum from the septum secundum) ≥2 mm.

Primary endpoint was a composite of stroke, vascular death, or TIMI major bleeding during a 2 year follow-up.

 

It included 120 patients between 2011 and 2017 randomized to PFO closure vs. medical treatment alone. The three high risk characteristics of PFO were assessed by transesophageal ECG and resulted similar in both groups.


Read also: ACC 2018 | Echocardiographic Data Help Better Choose Patients for Patent Foramen Ovale Closure.


All PFO closure procedures were successful.

 

Primary end point was exclusively observed in the medication only group (6/60 patients; combined events rate at two years, 12.9% [p=0.013]; ischemic stroke rate at 2 years, 10.5% [p=0.023]).

 

In the medical treatment group, events included ischemic stroke (n=5), intercranial bleeding (n=1), TIMI major bleeding (n=2) and transient ischemic attack (n=1).


Read also: Closure of Patent Foramen Ovale for the Treatment of Migraine.


In the PFO closure group, complications included the development of atrial fibrillation (n=2), pericardial effusion (n=1) and pseudo aneurysm (n=1). There were no fatal complications.

 

Conclusion

Transcatheter patent foramen ovale closure in patients with a history of cryptogenic stroke and high risk characteristics assessed by transesophageal ECG, results in a significantly lower rate of stroke, vascular death and major bleeding, compared against patients undergoing medical treatment alone.

 

Original title: Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial.

Reference: Pil Hyung Lee et al. Journal of the American College of Cardiology (2018), online before print.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TAVR in Small Annuli: What Valve Should We Use?

One of the major challenges of severe aortic stenosis are patients with small aortic annuli, defined as ≤430 mm² aortic valve area. This condition...

ACC 2025 | TAVI in Low-Risk Patients: 5-Year Outcomes of EVOLUTE LOW RISK

Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgery in low-risk patients with severe aortic stenosis. However, one of its main limitations...

ACC 2025 | BHF PROTECT-TAVI: Are Cerebral Protection Systems Necessary in TAVI?

TAVI has seen a steady increase in use, though stroke continues to be one of its unwanted complications, mostly ischemic and, less frequently, hemorrhagic. The...

ACC-2025 Congress Second Day Key Studies

BHF PROTECT-TAVI (Kharbanda RK, Kennedy J, Dodd M, et al.)The largest randomized  trial carried out across 33 UK centers between 2020 and 2024, assessing...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

SMART-CHOICE 3 | Efficacy and Safety of Clopidogrel vs Aspirin Monotherapy in High Risk Patients after Percutaneous Coronary Intervention

Courtesy of Dr. Juan Manuel Pérez. After post percutaneous coronary intervention (PCI) standard duration dual antiplatelet therapy (DAPT), the optimal long term monotherapy strategy is...

RACE Trial: Effect of Balloon Pulmonary Angioplasty and Riociguat on Right Ventricular Afterload and Function in Chronic Thromboembolic Pulmonary Hypertension

Even though pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), up to 40% of patients are not candidates because...

iFR- vs. FFR-Guided Coronary Revascularization: 5-Year Clinical Outcomes

The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional...