TCT-1017 Percutaneous PFO Closure Versus Medical Therapy for Prevention of Recurrent Stroke in Patients With Cryptogenic Stroke: A Comparative Clinical Outcomes Analysis

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Cryptogenic stroke accounts for nearly 25% of ischemic strokes, with PFO being implicated as a possible embolic source. The optimal strategy for secondary prevention remains debated—between medical therapy and transcatheter PFO closure. Our study objective was compare long-term clinical outcomes between PFO closure and medical therapy in patients with cryptogenic stroke. Methods: Data were analyzed from major randomized trials including RESPECT, CLOSE, and REDUCE. The primary outcome was recurrent ischemic stroke. Secondary outcomes included transient ischemic attack (TIA), major bleeding, atrial fibrillation, and all-cause mortality. Patient-level data were extracted, and pooled estimates were analyzed. Results: PFO closure significantly reduced the risk of recurrent stroke compared to medical therapy (HR 0.41, p< 0.001). However, the incidence of new-onset atrial fibrillation was significantly higher in the closure group (p< 0.001). No significant difference was found in major bleeding or mortality. Conclusion: In patients with cryptogenic stroke and PFO, percutaneous closure significantly reduces the risk of recurrent stroke compared to medical therapy alone (p< 0.001), with a modest increase in atrial fibrillation risk. Clinical decision-making should weigh this benefit against the arrhythmic risk and be guided by patient anatomy and preferences. Categories: STRUCTURAL: Congenital and Other Structural Heart Disease

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B435

Last Page

B435

Comments

Transcatheter Cardiovascular Therapeutics held 2025-10-25 to 2025-10-28 in San Francisco, CA

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