Effect of residual interatrial shunt on migraine burden after transcatheter closure of patent foramen ovale
Vaina, Lucia M.
Buonanno, Ferdinando S.
Hung, Judy W.
Palacios, Igor F.
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Citation (published version)Eyal Ben-Assa, Pablo Rengifo-Moreno, Rasha Al-Bawardy, Dhaval Kolte, Ricardo Cigarroa, Ignacio Cruz-Gonzalez, Rahul Sakhuja, Sammy Elmariah, Eugene Pomerantsev, Lucia M Vaina, MingMing Ning, Ferdinando S Buonanno, Judy W Hung, Ignacio Inglessis, Igor F Palacios. 2020. "Effect of residual interatrial shunt on migraine burden after transcatheter closure of patent foramen ovale." JACC Cardiovasc Interv, Volume 13, Issue 3, pp. 293 - 302. https://doi.org/10.1016/j.jcin.2019.09.042
OBJECTIVES: This study sought to evaluate the long-term effect of transcatheter patent foramen ovale (PFO) closure on migraineurs with and without aura and examine the effect of residual right-to-left shunt. BACKGROUND: Many studies reported improvement in migraine symptoms after PFO closure, yet randomized trials failed to reach its clinical endpoints. METHODS: The study retrospectively analyzed data from 474 patients who underwent transcatheter PFO closure at Massachusetts General Hospital. Patients completed a migraine burden questionnaire at baseline and at follow-up. Migraine severity is reported as migraine frequency (days/month), average duration (min), and migraine burden (days × min/month). Improvement following closure was defined as complete abolishment of symptoms or >50% reduction in migraine burden. RESULTS: A total of 110 migraineurs who underwent PFO closure were included; 77.0% had aura and 23.0% were without aura, and 91.0% had a cryptogenic stroke. During long-term median follow-up of 3.2 (interquartile range: 2.1 to 4.9) years, there was a significant improvement in migraine symptoms in migraineurs with or without aura. Migraine burden was reduced by >50% in 87.0% of patients, and symptoms were completely abolished in 48%. Presence of aura was associated with abolishment of migraine (odds ratio: 4.30; 95% confidence interval: 1.50 to 12.30; p = 0.006). At 6 months after PFO closure, residual right-to-left shunt was present in 26% of patients. Absence of right-to-left shunt was associated with improvement in migraine burden by >50% (odds ratio: 4.60; 95% confidence interval: 1.30 to 16.10; p = 0.017). CONCLUSIONS: Long-term follow-up after transcatheter PFO closure was associated with significant improvement in migraine burden. Aura was a predictor of abolishing symptoms. Absence of residual right-to-left shunt was a predictor of significant reduction in migraine burden.
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