Author + information
- Received May 8, 2019
- Revision received September 16, 2019
- Accepted September 24, 2019
- Published online February 3, 2020.
- Eyal Ben-Assa, MDa,b,∗ (, )
- Pablo Rengifo-Moreno, MDc,
- Rasha Al-Bawardy, MDa,
- Dhaval Kolte, MD, PhDa,
- Ricardo Cigarroa, MDa,
- Ignacio Cruz-Gonzalez, MDd,
- Rahul Sakhuja, MD MPPa,
- Sammy Elmariah, MD, MPHa,
- Eugene Pomerantsev, MD, PhDa,
- Lucia M. Vaina, MD, PhDe,
- MingMing Ning, MDe,
- Ferdinando S. Buonanno, MDe,
- Judy W. Hung, MDa,
- Ignacio Inglessis, MDa and
- Igor F. Palacios, MDa
- aCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bCardiology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- cCardiology Division, Tallahassee Memorial Hospital, Southern Medical Group, Tallahassee, Florida
- dServicio de Cardiología, Hospital Clínico Universitario de Salamanca-Instituto de Investigación Biomédica de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Salamanca, Spain
- eDepartment of Neurology and Cardio-Neurology Clinic, Clinical Proteomics Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Eyal Ben-Assa, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB8-852E, Boston, Massachusetts 02114.
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.
Dr. Sakhuja has served as a consultant for Edwards Lifesciences and Medtronic. Dr. Elmariah has served as a consultant for Medtronic; and has received research grant support from Svelte Medical and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 8, 2019.
- Revision received September 16, 2019.
- Accepted September 24, 2019.
- 2020 American College of Cardiology Foundation
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