Abstract Details

Title Creating and Implementing A Pathway to PFO Closure: A Combined Neurology-Cardiology Approach

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 124

Objective To determine the prevalence of patent foramen ovale (PFO) closure among ischemic stroke patients with PFO.

Background In April 2020, the �鶹��ýӳ�� published its Practice Advisory Update Summary: PFO and Secondary Stroke Prevention. Herein, we report our experience creating and implementing a pathway to PFO closure based on the recent guidelines.

Design/Methods We identified ischemic stroke patients with PFO who were managed by our stroke team between January 2017 and April 2020. Patients were identified using Cardiology’s implantable loop recorder registry (n=64) and EPIC’s Slicer Dicer function (n=80). Stroke diagnosis and etiology were adjudicated. Patients with missing work-up components were brought in for necessary studies (e.g., hypercoagulable labs). A minimum of 3 months of cardiac monitoring was required. The degree of shunting and anatomic features of the PFO seen on TTE, TEE, and/or TCD were taken into consideration. Completed case report forms, including RoPE score, were discussed at our Neurology-Cardiology monthly conference.

Results One hundred and forty patients with ischemic stroke and PFO were identified (mean age 61 years [min=22, max=91]; 28% women). Fifty-four percent (75/140) were >60 years old. Among those ≤60 years old (n=65), the committee recommended against closure in 17 patients (14 had an alternative mechanism of stroke, 3 had small PFO). Despite this recommendation, 2 PFOs were closed outside the university. Thirty patients remain under investigation. To date, 16% (18/110) of patients who have completed our pathway to PFO closure work-up have undergone PFO closure.

Conclusions

Fewer than 1/5 of our sample met criteria for PFO closure using the recent �鶹��ýӳ�� recommendations. Our experience suggests that a coordinated effort between Neurology and Cardiology is essential when selecting appropriate patients for PFO closure.

Authors/Disclosures
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA) PRESENTER	Dr. Albright has nothing to disclose.
Stephanie Loveless, NP (SUNY Upstate Medical University)	Mrs. Loveless has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Hesham Masoud, MD (Department of Neurology)	Dr. Masoud has nothing to disclose.
	No disclosure on file
Julius Latorre, MD, F�鶹��ýӳ�� (SUNY Upstate Med Univ Hosp/Neuro)	Dr. Latorre has nothing to disclose.