Author + information
- Received October 5, 2009
- Revision received October 28, 2009
- Accepted November 13, 2009
- Published online March 1, 2010.
- Gianluca Rigatelli, MD⁎,⁎ (, )
- Fabio Dell'Avvocata, MD⁎,
- Federico Ronco, MD⁎,
- Paolo Cardaioli, MD⁎,
- Massimo Giordan, MD⁎,
- Gabriele Braggion, MD†,
- Silvio Aggio, MD†,
- Mauro Chinaglia, MD‡,
- Giorgio Rigatelli, MD§ and
- Jack P. Chen, MD∥
- ↵⁎Reprint requests and correspondence:
Dr. Gianluca Rigatelli, Rovigo General Hospital, Section of Adult Congenital Heart Disease, Via Mozart, 9, Legnago, Verona 37045, Italy
Objectives In the present study, we sought to assess the effectiveness of migraine treatment by means of primary patent foramen ovale (PFO) transcatheter closure in patients with anatomical and functional characteristics predisposing to paradoxical embolism without previous cerebral ischemia.
Background The exact role for transcatheter closure of PFO in migraine therapy has yet to be elucidated.
Methods We enrolled 86 patients (68 female, mean age 40.0 ± 3.7 years) referred to our center over a 48-month period for a prospective study to evaluate severe, disabling, medication-refractory migraine and documented PFO. The Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine. Criteria for intervention included all of the following: basal shunt and shower/curtain shunt pattern on transcranial Doppler and echocardiography, presence of interatrial septal aneurysm and Eustachian valve, 3 to 4 class MIDAS score, coagulation abnormalities, and medication-refractory migraine with or without aura.
Results On the basis of our inclusion criteria, we enrolled 40 patients (34 females, mean age 35.0 ± 6.7 years, mean MIDAS 35.8 ± 4.7) for transcatheter PFO closure; the remainder continued on previous medical therapy. Percutaneous closure was successful in all cases, with no peri-procedural or in-hospital complications. After a mean follow-up of 29.2 ± 14.8 months (range 6 to 48 months), PFO closure was complete in 95%; all patients (100%) reported improved migraine symptomatology (mean MIDAS score 8.3 ± 7.8, p < 0.03). Specifically, auras were eliminated in 100% of patients after closure.
Conclusions Primary transcatheter PFO closure resulted in a very significant reduction in migraine in patients satisfying our criteria.
- Received October 5, 2009.
- Revision received October 28, 2009.
- Accepted November 13, 2009.
- American College of Cardiology Foundation