Recurrence of cryptogenic stroke or TIA in patients with patent foramen ovale successfully treated by using different kind of percutaneous occluder devices: five-year follow-up.

AIM: Cryptogenic stroke remains the final diagnosis in 40% of ischemic acute cerebrovascular events. Until now there are no clinical evidences that the percutaneous closure of PFO is able to prevent the recurrence of stroke or transient ischemic attack (TIA). The aim of this study was to evaluate the incidence of recurrence in patients successfully treated by percutaneous closure of PFO with different occluder devices by using TCD, TTE and clinical evaluation. METHODS: From February 2004 to November 2009, 72 pts, (40 females and 32 males; average age 46 yrs, range 14-66), admitted with diagnosis of recurrent ischemic neurologic events (58 stroke and 14 TIA) underwent percutaneous closure of PFO. Thirty-one (43%) of the 72 patients had a concomitant history of migraine, 16 (52%) of whom with aura. Five different occluder devices were used, with a total amount of 74 implants. All pts were studied during the follow-up by clinical evaluation (Rankin modified scale), TCD and TTE. RESULTS: Successful device deployment is achieved in 100% of pts without any periprocedural major complication. Only in two pts atrial arrhythmia have occurred. All pts was discharged within 3 days in good overall conditions. In all pts a double antiplatelet regimen was adopted. The follow-up was complete in 100% of the cases (median 30, range 3-58 months ). At five years, there was no recurrent stroke or TIA, and no new cerebral lesions developed by MRI in those patients with residual shunt. Moreover, in 65 (90%) of them the Rankin scale significantly (P<0.0001) reduced to 0 whereas only in 2 pts score 1 was reached. In 19 (61%) of the 31pts with concomitant migraine, the intensity and the frequency of the attacks significantly (P<0.0001) decreased over time. At the TCD, 5 pts (7%) resulted positive for microembolic signals but, only 1 of them, was successfully treated for an associate defect. The TTE evaluation showed however an optimal sealing of all the devices without signs of erosion, incomplete closure and thrombus formation around the device. CONCLUSION: Our experience suggests that percutaneous treatment of PFO is safe and beneficial at the medium term follow-up for secondary prevention since able to prevent the clinical recurrence of acute cerebrovascular events irrespective of the device used.

Falls in the elderly.

A substantial number of elderly persons living at home fall each year. Falling can lead to both physical and psychological harm, causing some to place unwarranted restrictions on themselves based on their fear of falling again. There are many causes of falls, including age-related changes in physical status, certain pathological states and environmental hazards. Thorough assessment of the patient who has fallen includes both a detailed history and a physical examination aimed at determining the extent of injury as well as the cause of the fall. Armed with this information, the nurse practitioner can design a fall-prevention educational program that fits the patient's specific needs. Fall-prevention education is appropriate for all elderly patients, not only those who have a history of falling.