Feature | Stroke | October 16, 2015

Long-Term RESPECT Trial Results Show PFO Closure Effective Against Recurrent Cryptogenic Stroke

Treatment with Amplatzer device proven superior to medical management, particularly in younger patients

RESPECT trial, long-term study results, TCT 2015, PFO closure, recurrent cryptogenic stroke

Image courtesy of GE Healthcare

October 16, 2015 — Long-term study results from the RESPECT trial found that closing a patent foramen ovale (PFO) with an Amplatzer PFO Occluder was superior to medical management in the prevention of recurrent cryptogenic stroke in patients who had previously experienced one.

Findings were reported at the 27th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium.

PFO is a small flap of two tissue layers between the atria that fuses shut in two-thirds of patients after birth but in the one-third of patients in which it stays open can allow blood clots to travel to the brain, causing a stroke. Current guidelines call for medical management with anticoagulants for patients with PFO following a cryptogenic stroke. The RESPECT study examined the use of a device that closes the flap compared with medical management. A total of 980 subjects between 18 and 60 years of age were randomized to PFO closure (N=499) or medical management (N=481). Original enrollment ended when 25 ischemic stroke events occurred; the present report details longer-term follow-up from the trial.

The mean follow-up for the PFO group was 5.5 years and 4.9 years for the medical management group [total patient years: 2,769 (PFO) and 2,376 (medical management)]. The overall intent-to-treat analysis showed no statistically significant difference in the incidence of all-cause strokes, which included both cryptogenic and “other” strokes (p=0.16). When subsequent strokes were restricted to cryptogenic stroke, there was a 54 percent relative risk reduction in recurrent cryptogenic stroke for the PFO closure group (p=0.042), although the absolute number of strokes remained small. An additional sensitivity analysis of all-cause stroke in patients under the age of 60 (where a greater proportion of strokes are likely to be cryptogenic) showed a 52 percent relative risk reduction (p=0.035). Additional benefit was also seen within a subgroup in two-thirds of RESPECT patients who had PFO characteristics of substantial shunt or atrial septal aneurysm with a 75 percent reduction in cryptogenic stroke risk (p=0.007).

Analysis of PFO closure procedure or device-related serious adverse events found no intra-procedure strokes, device embolization, device thrombosis or device erosion. There was a low rate of major vascular complications (0.9 percent) and device explants (0.4 percent).

“The long-term results of the RESPECT trial show that PFO closure is superior to medical management in reducing recurrent cryptogenic ischemic stroke,” said lead investigator John D. Carroll, M.D. Carroll is professor of medicine at the University of Colorado School of Medicine and director, interventional cardiology at the University of Colorado Hospital in Denver. “The procedure and device have proven to be safe.”

RESPECT was funded by St. Jude Medical. Carroll reported receiving consulting fees as a member of the Steering Committee for the RESPECT trial from St. Jude Medical.

For more information: www.tctconference.com

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