Background
Current international guidelines recommend closure of PFOs in selected individuals under 60 years old within six-months of stroke. This audit describes management and outcomes of patients with PFO following ischaemic stroke in a single New Zealand centre, and to assess concordance with guidelines-recommended care.
Methods
We conducted a retrospective audit at Wellington Regional Hospital. Patients included were aged 18-59 years, admitted with ischaemic stroke and confirmed PFO between 2016 and 2025. Data were obtained from the electronic patient record, including clinical characteristics, TOAST classification, imaging modalities, management strategies, timing of PFO closure and complications.
Results
Of 434 young ischaemic stroke patients (147 TOAST 5, 2 TOAST 4 paradoxical) 176 had bubble contrast ECHO (96 TOAST 5, 2 TOAST 4 paradoxical); 54 had PFO. 34 (63%) underwent closure; 31 (91.2%) were TOAST 4 and 5, 3 (8.8%) were TOAST 3. 6 ongoing workup for closure, 8 PFO incidental/declined, 5 lost to follow-up, 1 died. 20% were closed within six months of index stroke; median time to closure 312 days (95% CI 253-416). 4 (7.4%) of patients had a recurrent stroke pre-closure. No clinically relevant complications were observed. 2 patients had stroke after percutaneous closure. All patients were prescribed antithrombotic therapy.
Conclusions
The majority of patients with PFO are referred for closure. Given length of time to closure it appears patients are at risk of recurrent stroke, which will be the target of a quality improvement project also includng addressing the appropriate use of bubble contrast ECHO in cryptogenic stroke.