Utilidad del cierre del foramen oval permeable en pacientes con AVE criptogénico

Antecedentes: El foramen oval permeable (FOP) es un hallazgo frecuente en pacientes con accidente vascular encefalico criptogenico (AVEC), y se discute la utilidad de su cierre percutaneo (CP). Objetivo: Evaluar el riesgo de recurrencia de eventos neurologicos en pacientes con AVEC y FOP, y compararlos entre aquellos tratados medicamente y los sometidos a CP. Metodos: Entre los 106 pacientes admitidos por AVEC y FOP, en el periodo 2003 a 2006, determinamos la aparicion de nuevos eventos neurologicos isquemicos (NEN), y estudiamos sus factores determinantes y comparamos los que se sometieron a CP versus lo que continuaron con tratamiento medico, segun criterio del tratante. Se consignaron las caracteristicas clinicas y de la antomia del FOP en el ecocardiograma Los NEN se confirmaron por examen neurologico y/o neuro-imagenes. Para el analisis de los datos se utilizo chi-cuadrado y regresion logistica.Resultados: Entre los 106 pacientes evaluados, 87 siguieron tratamiento medico y 19 CP. Los pacientes sometidos a CP presentaban mayor asociacion de FOP con aneurisma del septum interauricular (ASI) (57,9% versus 35,6%, p=0,05). El seguimiento fue de 27 +/-13 meses. En este periodo se demostro un 12,6% de nuevo evento neurologico entre los tratados medicamente, mientras que ninguno lo presento entre los sometidos al CP (NS). El unico predictor independiente para NEN fue el ASI asociado con FOP; OR: 8,45 (1,56-60,46). Conclusiones: De acuerdo a nuestros resultados, los pacientes con AVEC y FOP tienen alto riesgo de recurrencia cuando el FOP se asocia a ASI y aparentemente se benefician con CP. Background: Patent Foramen Ovale (PFO) is a frequent finding in patients with cryptogenic stroke (CS). Theeffect of closing the PFO in this setting is debated. Aim: to evaluate de risk of stroke recurrence in patients with CS and PFO; to compare this risk in patients followed under medical treatment with those undergoing percutaneous closure of PFO. Methods: From 2003 to 2006, 106 patients were admitted with a CS and the presence of PFO was documented by echocardiography. New ischemic strokes and risk factors were compared between those who weresubmitted to percutaneous closure of PFO and those treated in a conventional way. The decision to close thePFO was taken by the physician in charge. Clinical findings and echocardiographic characteristics of thePFO were recorded. New ischemic events were diagnosed by neurologic assessment and/or imaging techniques. Data was analyzed by chi square testing and logistic regression. Results: 87 patients were followed under medical treatment and 19 had closure of the PFO. The latter group had a greater incidence of atrial septal aneurysm (57.9% vs. 35.6%, p=0.05). The mean follow up was 27 +/- 13 months.New ischemic stroke occurred in 12.6% in the medically treated group while none was observed in the PFO closure group (NS). The sole independent predictor of new stroke was the presence of atrial septal aneurysm (OR: 8.45, 95% C.I. 1.56 - 60.46) Conclusion: Patients with CS and PFO are at considerable risk of developing new strokes, especially those with concomitant atrial septal aneurysm. Closure of PFO was apparently useful to prevent this risk.