ABSTRACT NUMBER: ESOC2026A677 LONG-TERM OUTCOME OF PATENT FORAMEN OVALE CLOSURE FOR SECONDARY STROKE PREVENTION

Abstract Background and aims Patent foramen ovale (PFO) is associated with cryptogenic stroke, particularly in young adults with atrial septal aneurysm. This study aimed to evaluate long-term outcomes in a cohort of patients who underwent PFO closure for secondary stroke prevention. Methods This retrospective study included patients who underwent PFO closure between 1 January 2008 and 31 December 2023 due to ischemic stroke or transient ischemic attack. RoPE and PASCAL scores were calculated from clinical data at the time of the index cerebrovascular event. Long-term outcomes, identified through electronic medical records, included recurrent ischemic stroke (RIS), atrial fibrillation (AF), systemic thromboembolism (ST), myocardial infarction (MI), and all-cause mortality. Results A total of 89 patients were included, with a median age of 45 years (IQR 21), and the mean follow-up duration was 84.6 months (SD 51.7). Outcome events occurred in 14% of patients, including RIS in 6% (median 16.7 months, IQR 14.0), AF in 3% (median time to event 2.3 months, IQR 57), ST in 3% (median 62.5 months, IQR 60.6), and MI in 2% (median 104.3 months, IQR 8.4). Two patients died. A RoPE score ≥7 was observed in 56% of patients. Among patients with RIS, RoPE scores were predominantly 6-7 (median 6, IQR 1), while PASCAL classification was mainly “possible” or “unlikely”. Conclusions These findings underscore the importance of carefully selecting patients for PFO closure, considering that the PFO may not be causally related to the index stroke. Risk stratification remains essential, as recurrent ischemic stroke and cardiovascular events may occur despite closure. Conflict of interest Nothing to disclose