PFO Closure Devices: The Disconnect Between Technology, Technique, and Indications for Use

摘要

This issue contains four articles on the outcomes of device closure for patent foramen ovale (PFO) [1-4]. The number of patients in these reports ranges from one to almost 250. The reports characterize outcomes with four different devices: Amplatzer Cribriform occluder (AGA Medical, Plymouth, MN), STARFelx (NMT Medical technologies, Boston, MA), Solysafe Septal Occluder (Swissimplant AG, Solothum, Switzerland), and the Intrasept Occluder (Cardia, Eagan, MN). In the aggregate, these reports generally reflect the state-of-the-art for our understanding of the place of PFO in cryptogenic stroke, and the development of device therapy for PFO closure. The similarities in many ways overcome the differences among these reports and devices. The patient cohorts are remarkably homogenous with a mean age in the early 50s among patients with cryptogenic stroke or transient ischemic attack found to have PFO. Although the technical details of the use of the four devices in these reports vary, they are all devices with a fabric material in conjunction with a wire frame and create what is commonly called a double umbrella configuration. The closure rates are similar with acute closure in over two-thirds of patients and anywhere from 90 to 100% at 6-12 months estimated by color Doppler or agitated saline examinations.