Percutaneous closure of patent foramen ovale after cryptogenic stroke - a comparison between patients < 60 versus ≥ 60 years-of-age.

Cryptogenic ischemic stroke is strongly associated with patent foramen ovale (PFO). Current guidelines recommend percutaneous PFO closure in patients < 60 years-of-age. This study aimed to compare the incidences of recurrent stroke or transient ischemic attack (TIA), and atrial fibrillation after percutaneous PFO closure in patients aged ≥ 60 years with patients < 60 years-of-age. This retrospective study included all adult Swedish patients with cryptogenic stroke treated with percutaneous closure of PFO 2001–2023. Patient characteristics and procedural details were obtained from the Swedish registry of adult congenital heart disease. Preprocedural atrial fibrillation and post-procedural incidence of recurrent cerebral infarction, TIA, and atrial fibrillation were obtained from the Swedish National Board of Health and Welfare’s registry of patient diagnoses. To compare differences across age groups, logistic-, quantile-, and linear regression models were used. P-values < 0.050 were considered significant. In total, 1,101 patients were included with follow-up time 7.1 ± 5.8 years, of which 12% (n = 134) were ≥ 60 years-of-age. Low prevalence of preprocedural comorbidity was seen in both age groups and there was no difference in incidence of atrial fibrillation within 3 months after PFO closure (≥ 60 years-of-age n = 4, 3.0%, < 60 years-of-age n = 23, 2.4%, p = 0.229), or recurrent cerebral infarction/TIA (≥ 60 years-of-age n = 3, 2.7%, < 60 years-of-age n = 17, 1.5%, p = 0.697) between the age groups. Based on the results from this nation-wide study, percutaneous PFO closure can be considered a safe and efficient therapy in the reduction of recurrent stroke in patients older than 60 years with low preprocedural comorbidity.