Am J Cardiovasc Dis 2012;2(2):89-95

Original Article
Improving migraine by means of primary transcatheter patent foramen
ovale closure: long-term follow-up

Gianluca Rigatelli, Fabio Dell’Avvocata, Paolo Cardaioli, Massimo Giordan, Gabriele Braggion, Silvio Aggio, Roberto L’
Erario, Mauro Chinaglia

Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo
General Hospital, Rovigo, Italy; Division of Cardiology, Echocardiography Lab, Rovigo General Hospital, Rovigo, Italy;
Department of Neuroscience, Rovigo General Hospital, Rovigo, Italy

Received January 10, 2012; accepted February 9, 2012; Epub May 20, 2012; Published June 15, 2012

Abstract: Objective. We sought to assess the long-term faith of migraine in patients with high risk anatomic and functional
characteristics predisposing to paradoxical embolism submitted to patent foramen ovale (PFO) transcatheter closure.
Methods. In a prospective single-center non randomized registry from January 2004 to January 2010 we enrolled 80
patients (58 female, mean age 42±2.7 years, 63 patients with aura) submitted to transcatheter PFO closure in our center.
All patients fulfilled the following criteria: basal shunt and shower/curtain shunt pattern on transcranial Doppler and
echocardiography, presence of interatrial septal aneurysm (ISA) and Eustachian valve, 3-4 class MIDAS score, coagulation
abnormalities, medication-refractory migraine with or without aura. Migraine Disability Assessment Score (MIDAS) was
used to assess the incidence and severity of migraine before and after mechanical closure. High risk features for
paradoxical embolism included all of the following. Results. Percutaneous closure was successful in all cases (occlusion
rate 91.2%), using a specifically anatomically-driven tailored strategy, with no peri-procedural or in-hospital complications;
70/80 of patients (87.5%) reported improved migraine symptomatology (mean MIDAS score decreased 33.4±6.7 to 10.6±9.
8, p<0.03) whereas 12.5% reported no amelioration: none of the patients reported worsening of the previous migraine
symptoms. Auras were definitively cured in 61/63 patients with migraine with aura (96.8%). Conclusions. Transcatheter
PFO closure in a selected population of patients with severe migraine at high risk of paradoxical embolism resulted in a
significant reduction in migraine over a long-term follow-up. (AJCD1201001).

Keywords: Migraine, stroke, patent foramen ovale, transcatheter closure

Address all correspondence to:
Dr. Gianluca Rigatelli
Via Mozart, 9 ,37045 Legnago
Verona – Italy.
Tel: +3903471912016; Fax: +39044220164
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