Ticagrelor for Refractory Migraine/Patent Foramen Ovale (TRACTOR)

Neurology ◽  
2018 ◽  
Vol 91 (22) ◽  
pp. 1010-1017 ◽  
Author(s):  
Adam M. Reisman ◽  
Barbara T. Robbins ◽  
Denise E. Chou ◽  
Marianna Shnayderman Yugrakh ◽  
Giti J. Gross ◽  
...  
Keyword(s):  
Side Effects ◽  
Randomized Trial ◽  
Patent Foramen Ovale ◽  
Additional Treatment ◽  
Foramen Ovale ◽  
Small Pilot Study ◽  
Serious Adverse Events ◽  
Medication Side ◽  
Refractory Migraine

ObjectiveAfter finding that the thienopyridines clopidogrel and prasugrel reduced migraine headache (MHA) symptoms in some patients with patent foramen ovale (PFO), this small pilot study was undertaken to determine whether ticagrelor, a nonthienopyridine P2Y12 inhibitor, would have similar MHA effects and might be better suited for a future randomized trial.MethodsMHA patients were screened for PFO. Participants with documented right to left shunt (RLS) and ≥6 monthly MHA days received ticagrelor therapy for 28 days. Those with ≥50% reduction in monthly MHA days were deemed responders and completed 2 additional treatment months.ResultsThe 40 participants had a mean age of 36.2 years and mean MHA frequency of 17.4 d/mo. A total of 39/40 were female. A total of 14/40 met criteria for episodic MHA, 26/40 for chronic MHA, 14/40 had migraine with aura, and 22/40 had a moderate–large RLS (Spencer grade ≥4). Seventeen of 40 participants (43%) were responders. MHA reduction continued through 3 treatment months in all responders. MHA responder rates were not statistically different in participants with episodic or chronic MHA, with or without aura, or with small/larger RLS shunt magnitude. Thirteen (32%) patients had medication side effects, without serious adverse events.ConclusionP2Y12 inhibition with ticagrelor reduced MHA symptoms similarly to our previous thienopyridine experience, but participants seemed to have a less robust MHA benefit and more frequent side effects than with the thienopyridines, making it an inferior choice for a randomized trial.Classification of evidenceThis study provides Class IV evidence that ticagrelor reduced MHA symptoms in patients with PFO.

P5348Aspirin versus clopidogrel treatment for refractory migraine with patent foramen oval

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Toomsoo
Keyword(s):  
Side Effects ◽  
Migraine With Aura ◽  
Observational Studies ◽  
Transcranial Sonography ◽  
Additional Treatment ◽  
Serious Adverse Events ◽  
High Prevalence ◽  
Clopidogrel Therapy ◽  
Reduction Effect ◽  
Refractory Migraine

Abstract Background The association between migraine with aura (MA+) and persistent foramen ovale (PFO), as well as other right-to-left shunts, is described. Observational studies suggested that when a PFO is closed patients who have MA+ are usually improved. Many observational studies have shown that when PFOs are closed in patients who have had a stroke the patients have a high prevalence of migraine before the procedure and ∼80% report that their migraine symptoms were improved after the closure procedure. Migraine with aura is also improved by medical treatment (aspirin, clopidogrel). Purpose To investigate the MA+ reduction effect with the aspirin or clopidogrel in 90 with MA+ with PFO. Methods MA+ patients were screened for PFO by transcranial sonography and echocardiography. Participants with documented right to left shunt (RLS) and ≥12 monthly MA+ days received aspirin or clopidogrel therapy for 60 days. Those with ≥50% reduction in monthly MA+ days were deemed responders and completed 10 additional treatment months. Results The 90 participants had a mean age of 33.2 years and mean MA+ frequency of 16.4 d/mo. A total of 57/80 were female. A total of 66/80 met criteria for episodic MA+, 14/80 for chronic MA+, 59/80 had a moderate–large RLS. 38 of 80 participants (47%) were responders. MA+ reduction continued through 10 treatment months in all responders. MA+ responder rates were not statistically different in participants with episodic or chronic MA+ or with small/larger RLS shunt magnitude, treatment with aspirin or with clopidogrel. All three (8%) patients had aspirin side effects, without serious adverse events. Conclusion Both medications reduced MA +symptoms and participants seemed to have less MA+ and only small amount had side effects with aspirin. Acknowledgement/Funding None

scholarly journals Effective prophylaxis of visual and neurological disturbances with an anti-endothelin drug: analysis of 1642 sclerotherapy sessions

2016 ◽  
Vol 5 (2) ◽  
Author(s):  
Alessandro Frullini ◽  
Angelo Guastini ◽  
Demetrio Guarnaccia ◽  
O. Walter Loparco ◽  
Domenico Maurano ◽  
...  
Keyword(s):  
Side Effects ◽  
Patent Foramen Ovale ◽  
Air Embolism ◽  
Drug Analysis ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Neurological Manifestations ◽  
Foramen Ovale ◽  
Retrospective Assessment ◽  
Effective Prophylaxis

In the literature cases of stroke and transient neurological symptoms have been described after sclerotherapy for chronic venous disease The initial interpretation of these phenomena was that of a micro air embolism in association with a patent foramen ovale. This explanation did not always manage to justify all neurological manifestations. Recent theories have demonstrated that in the area of sclerosis, a significant amount of endothelin 1. We carried out a retrospective assessment of sclerotherapy case studies on 540 patients at ten phlebological centres to search for a relationship between the use of aminaftone (a venotropic drug with demonstrated anti-endothelin action) and the occurrence of side effects after sclerotherapy was performed. Significant reduction of side effects was observed in sclerotherapy for teleangectasias and in patients with migraine history.

Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale–Associated Stroke

2020 ◽  
Vol 77 (7) ◽  
pp. 878 ◽  
Author(s):  
Akram Y. Elgendy ◽  
Jeffrey L. Saver ◽  
Zahid Amin ◽  
Konstantinos Dean Boudoulas ◽  
John D. Carroll ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Causative Mechanism

scholarly journals Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale

2013 ◽  
Vol 34 (43) ◽  
pp. 3362-3369 ◽  
Author(s):  
M. Hornung ◽  
S. C. Bertog ◽  
J. Franke ◽  
D. Id ◽  
M. Taaffe ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Patent Foramen Ovale ◽  
Percutaneous Closure ◽  
Long Term Results ◽  
Foramen Ovale

Comparison of Three Patent Foramen Ovale Closure Devices in a Randomized Trial (Amplatzer Versus CardioSEAL-STARflex Versus Helex Occluder)

2008 ◽  
Vol 101 (9) ◽  
pp. 1353-1358 ◽  
Author(s):  
Margaret Taaffe ◽  
Evelyn Fischer ◽  
Andreas Baranowski ◽  
Nicolas Majunke ◽  
Corinna Heinisch ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Patent Foramen Ovale ◽  
Foramen Ovale

scholarly journals Transcatheter Patent Foramen Ovale Closure Guided Only by Transesophageal Echocardiography Without fluoroscopy

2020 ◽  
Author(s):  
Tianli Zhao ◽  
Qin Wu ◽  
Hendrik Ruge ◽  
Rüdiger Lange ◽  
Yifeng Yang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Clinical Experiences ◽  
Serious Adverse Events ◽  
Ischemic Attack ◽  
Pfo Closure

Abstract Background Standby of transesophageal echocardiography (TEE) is necessary for any PFO closure in case of some cases with complicated anatomy of patent foramen ovale (PFO). The safety and effectiveness of Transcatheter PFO closure guided only by TEE navigation without fluoroscopy is unclear.Methods From 2017.06 to 2019.11, we included 38 patients who were recommended for PFO closure by the department of neurology at our hospital. The procedure was performed in a regular operating room by TEE navigation without fluoroscopy. Follow-up was given at 1st month, 3rd month, 6th month, 1st year and 2nd year after operation for each patient.Results All 38 patients were successfully performed PFO-closure guided by TEE. Procedural and intrahospital survival was 100%. Survival after a mean follow-up of 17.1±1.6months was 100%. "Catheter in sheath” technique was adopted in 16 cases. After the procedure, all 28 migraines with aura alleviated at different degree. All 10 patients suffering from pre-operational cryptogenic stroke survived and showed no evidence for recurrence of stroke (fatal or non-fatal), peripheral embolism or transient ischemic attack during follow-up. No serious adverse events in the PFO closure procedure and during the follow-up period.Conclusion First clinical experiences showed that percutaneous TEE guided PFO closure is safe and effective and might be promoted.

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