International PFO Consortium

NCT ID: NCT00859885

Last Updated: 2017-12-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

1500 participants

Study Classification

OBSERVATIONAL

Study Start Date

2008-09-08

Study Completion Date

2021-12-31

Brief Summary

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The prevalence of patent foramen ovale (PFO) is about 25% in the general population and approximately 40% in patients who have ischemic stroke of unknown cause (cryptogenic stroke). Given the large number of asymptomatic patients, no primary prevention is currently recommended. On the contrary, secondary prevention is very important. Prospective studies have shown that antithrombotic treatment (ATT) with aspirin or warfarin appears to negate the risk of recurrent stroke associated with a PFO. Patients with spontaneous or large right-to-left shunts (RLS), those with a coinciding atrial septal aneurysm (ASA) or multiple ischemic events prior to the PFO diagnosis may still be at increased risk of stroke recurrence despite ATT. Percutaneous device closure (PDC) is a challenging alternative to ATT. Several studies reported 0% to 3.4% annual recurrence rates of stroke or TIA in patients treated by PDC. To date, there is no data from randomized controlled trials (RCT) comparing the risk of stroke recurrence after PDC with that under ATT only. The results from ongoing RCTs are not to be awaited in the near future, mainly due to low enrolment and event rates. Alternative data-gathering strategies such as multicenter registries are needed to overcome the low recruitment rates. The aim of the present study is to compare the risk of recurrent stroke and TIA in patients with PFO and otherwise unexplained stroke who undergo PDC or receive ATT.

Detailed Description

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Background

The prevalence of patent foramen ovale (PFO) is about 25% in the general population and approximately 40% in patients who have ischemic stroke of unknown cause (cryptogenic stroke). Given the large number of asymptomatic patients, no primary prevention is currently recommended. On the contrary, secondary prevention is very important. Prospective studies have shown that antithrombotic treatment (ATT) with aspirin or warfarin appears to negate the risk of recurrent stroke associated with a PFO. Patients with spontaneous or large right-to-left shunts (RLS), those with a coinciding atrial septal aneurysm (ASA) or multiple ischemic events prior to the PFO diagnosis may still be at increased risk of stroke recurrence despite ATT. Percutaneous device closure (PDC) is a challenging alternative to ATT. Several studies reported 0% to 3.4% annual recurrence rates of stroke or TIA in patients treated by PDC. To date, there is no data from randomized controlled trials (RCT) comparing the risk of stroke recurrence after PDC with that under ATT only. The results from ongoing RCTs are not to be awaited in the near future, mainly due to low enrolment and event rates. Even if RCTs are completed successfully, statistical differences may remain undetected with the planned sample sizes. Alternative data-gathering strategies such as multicenter registries are needed to overcome the low recruitment rates.

Objective

1\) To compare the risk of recurrent stroke and TIA in patients aged ≤ 55 years with PFO and otherwise unexplained stroke who undergo PDC or receive ATT only; 2) To assess the etiological role of PFO for stroke/TIA in patients aged \> 55 years; 3) To assess the risk of recurrent stroke/TIA in "high-risk" PFO patients (i.e. those with spontaneous (at rest) or large RLS, coinciding ASA, or multiple previous cerebrovascular events).

Methods

Multicenter prospective non-randomized study with scheduled 3-years follow-up of patients with PFO and ischemic stroke or TIA. Participating centers: Swiss University Hospitals of Basel, Bern, Geneva, Lausanne and Zurich, the Cantonal Hospital of Aarau, the Triemli Hospital, the Alfried-Krupp Krankenhaus of Essen, the University Hospital of Essen, the Klinikum Worms gGmbH, Tufts Medical Center, Baystate Medical Center, the East Medical Center Tyler, and the University Hospital of Leuven.

Conditions

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Stroke Transient Ischemic Attack

Keywords

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patent foramen ovale ischemic stroke transient ischemic attack secondary prevention medical treatment percutaneous device closure

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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1

Patients who receive antithrombotic treatment only

Antithrombotic treatment

Intervention Type DRUG

antiplatelets, anticoagulants

2

Patients who undergo percutaneous device closure

percutaneous device closure of PFO

Intervention Type DEVICE

umbrella device for PFO closure

Interventions

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Antithrombotic treatment

antiplatelets, anticoagulants

Intervention Type DRUG

percutaneous device closure of PFO

umbrella device for PFO closure

Intervention Type DEVICE

Other Intervention Names

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aspirin clopidogrel

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years
* Diagnosis of PFO established by transesophageal echocardiography (TEE)
* Ischemic stroke or transient ischemic attack within the previous 6 months

Exclusion Criteria

* Non-vascular origin of the neurological symptoms after brain imaging (CT scan or MRI)
* Comorbid condition that would interfere with the study
* Pregnancy
* History of intracranial bleeding, confirmed arterio-venous malformation, aneurysm or uncontrolled coagulopathy
* Contraindications for TEE, echocardiographic or iodine contrast media
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Basel, Switzerland

OTHER

Sponsor Role collaborator

University of Lausanne Hospitals

OTHER

Sponsor Role collaborator

University Hospital, Geneva

OTHER

Sponsor Role collaborator

University Hospital, Zürich

OTHER

Sponsor Role collaborator

Triemli Hospital

OTHER

Sponsor Role collaborator

Cantonal Hospital of Aarau, Switzerland

OTHER

Sponsor Role collaborator

Alfried-Krupp Krankenhaus of Essen, Germany

UNKNOWN

Sponsor Role collaborator

University Hospital, Essen

OTHER

Sponsor Role collaborator

Klinikum Worms

OTHER

Sponsor Role collaborator

Tufts Medical Center

OTHER

Sponsor Role collaborator

Baystate Medical Center

OTHER

Sponsor Role collaborator

East Medical Center Tyler, Texas

UNKNOWN

Sponsor Role collaborator

Universitaire Ziekenhuizen KU Leuven

OTHER

Sponsor Role collaborator

Ammerland Klinik GmbH, Westerstede, Germany

UNKNOWN

Sponsor Role collaborator

University Hospital, Ghent

OTHER

Sponsor Role collaborator

Azienda USL Reggio Emilia - IRCCS

OTHER_GOV

Sponsor Role collaborator

Insel Gruppe AG, University Hospital Bern

OTHER

Sponsor Role lead

Responsible Party

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University of Bern and Triemli Hospital Zurich

Principal Investigators

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Krassen Nedeltchev, MD

Role: PRINCIPAL_INVESTIGATOR

Kantonsspital Aarau

Marie-Luise Mono, MD

Role: PRINCIPAL_INVESTIGATOR

Dep. of Neurology, Bern University Hospital, Bern

Marcel Arnold, MD

Role: STUDY_DIRECTOR

University of Bern, Inselspital

Locations

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Tufts Medical Center

Boston, Massachusetts, United States

Site Status RECRUITING

Baystate Medical Center

Springfield, Massachusetts, United States

Site Status COMPLETED

East Medical Center

Tyler, Texas, United States

Site Status RECRUITING

University Hospital Gent

Ghent, , Belgium

Site Status RECRUITING

Leuven University Hospital

Leuven, , Belgium

Site Status RECRUITING

Alfried Krupp Hospital

Essen, , Germany

Site Status RECRUITING

Essen University Hospital

Essen, , Germany

Site Status RECRUITING

Ammerland Klinik GmbH

Westerstede, , Germany

Site Status RECRUITING

Klinikum Worms gGmbH

Worms, , Germany

Site Status RECRUITING

Arcispedale Santa Maria Nuova, Department of Neurology, ASMN IRCCS

Reggio Emilia, , Italy

Site Status RECRUITING

University Hospital Doctor Josep Trueta

Girona, , Spain

Site Status RECRUITING

Cantonal Hospital of Aarau

Aarau, , Switzerland

Site Status RECRUITING

Basel University Hospital

Basel, , Switzerland

Site Status COMPLETED

Department of Neurology, Bern University Hospital, Bern

Bern, , Switzerland

Site Status RECRUITING

Geneva University Hospital

Geneva, , Switzerland

Site Status RECRUITING

Lausanne University Hospital

Lausanne, , Switzerland

Site Status RECRUITING

Zürich Triemli Hospital

Zurich, , Switzerland

Site Status COMPLETED

Zürich University Hospital

Zurich, , Switzerland

Site Status RECRUITING

Countries

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United States Belgium Germany Italy Spain Switzerland

Central Contacts

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Krassen Nedeltchev, MD

Role: CONTACT

Phone: +41 62 838 66 75

Email: [email protected]

Marie-Luise Mono, MD

Role: CONTACT

Phone: +41316320743

Email: [email protected]

Facility Contacts

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Dimitri Hemelsoet, MD

Role: primary

Andreas Müller-Eichelberg, MD

Role: primary

Joaquín Serena, MD

Role: primary

Marie-Luise Mono

Role: primary

Other Identifiers

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117/08

Identifier Type: -

Identifier Source: org_study_id