Analysis Of The Efficacy Of Percutaneous PFO Closure For Migraine And Influencing Factors Of Postoperative RRLS

Objective:To explore the efficacy and influencing factors of patent foramen ovale(PFO)closure in the treatment of migraine,the predictive factors of complete abolishment of migraine symptoms after PFO closure,and the related factors of residual right to left shunt(rRLS)after PFO closure.Methods:A total of 204 patients with PFO complicated with migraine in the presence of moderate-to-large right to left shunt(RLS)who underwent transcatheter PFO closure were retrospectively enrolled from January2020 to December 2020 in our hospital.According to the migraine burden at one year after PFO closure,the patients were divided into migraine abolished group(complete disappearance of migraine symptoms),migraine alleviated group(reduced migraine burden >50%),and poor effect group(reduced migraine burden <50%),according to the rRLS at one year after PFO closure,the patients were divided into a group with rRLS and a group without rRLS.The symptoms features of migraine patients before and after PFO closure were compared,the efficacy and influencing factors of migraine after PFO closure were analyzed,and the perioperative and long-term complications of PFO closure were evaluated.Results:Compared with the baseline,the migraine frequency,average migraine duration and NRS score were significantly decreased at 6 and12 months after PFO closure(all P<0.001).The course of headache,the proportion of ASA,and the proportion of 1-year postoperative rRLS in the poor effect group were significantly higher than that in the migraine abolished group and the migraine alleviated group(all P<0.05).Multivariable Logistic analysis showed that the course of headache(OR,0.961;95%CI,0.931-0.993;P=0.017)and 1-year postoperative rRLS(OR,0.376;95%CI,0.179-0.786;P=0.009)were influencing factors of complete abolishment of migraine symptoms after PFO closure.At 1 year after PFO closure,the length of PFO thin area in the group with rRLS was larger than that in the group without rRLS [(19.60 ±4.73)vs(17.64±3.71),P<0.05].Multivariable Logistic analysis showed that the length of PFO thin area is an influencing factor of 1-year postoperative rRLS after PFO closure.During the retrospective study period,the incidence of complications after PFO closure was 2.9%(6/204).Conclusions:(1)Percutaneous PFO closure can improve the headache symptoms in most migraine patients with moderate-to-large RLS;(2)The course of migraine headache and 1-year postoperative rRLS are influencing factors of complete abolishment of migraine symptoms after PFO closure,the shorter the course of preoperative headache and the absence of rRLS 1year postoperatively,the greater the likelihood of complete abolishment of migraine symptoms after PFO closure;(3)The length of the PFO thin area is an influencing factor of 1-year postoperative rRLS,the larger the PFO thin area,the higher the risk of having rRLS at 1 year postoperatively.