Precutaneous High Risk Patent Foramen Ovale to Treat Migraine Headaches

Patent Foramen Ovale Clinical Trial

Official title:

Precutaneous High Risk Patent Foramen Ovale to Treat Migraine Headaches:A Prospective,Multicenter,Randomized,Controlled Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT02777359
• Other study ID #: XJTU1AF-CRF-2015-008
• Status: Recruiting
• Phase: Phase 2
• First received: May 4, 2016
• Last updated: July 18, 2017
• Start date: January 2017
• Est. completion date: June 2018

Study information

• Verified date: July 2017
• Source: First Affiliated Hospital Xi'an Jiaotong University
• Contact: Zhang Yu Shun, PHD
• Phone: 0086-029-85324625
• Email: zys2889[@]sina.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The foramen ovale, a kind of physiologic channel in the interatrial septum in the heart at embryonic stage, is closed normally at 5-7 months after birth. When it is not closed, it is referred to as the patent foramen ovale (PFO), which is found in approximately 1/4 of general population. It was shown in the studies in recent years that the risks of cryptogenic stroke, migraine, peripheral arterial embolism and decompression sickness in the patients with PFO were several times higher than those in healthy people. Therefore, PFO, previously considered a condition without the necessity of treatment, causes the attention of many experts and scholars around the world. Migraine with or without aura is defined as one of the most disabling chronic diseases, since according to WHO, the disability adjusted life year caused by migraine was second only to that by non-fatal stroke in 2005. In recent years, an increasing number of researches suggested that migraine is closely related to the right-to-left shunt (RLS) in the heart. And PFO is clinically considered as the most common cause of RLS.

The closure treatment for PFO-induced migraine has been gradually applied in several hospitals in China. The relationship of PFO with migraine, however, was not evaluated systematically based on specific standards, unfortunately leading to non-inclusion of many high-risk patients with PFO in the evaluation. The following aspects are to be fully recognized: the selecting and screening procedures for the high-risk population with PFO-induced migraine; the indications and standards of closure treatment for PFO in the patients with PFO-induced migraine; and the possibility that the made-in-China occluders substitute for those imported in the prevention from migraine. Furthermore, there is still a lack of prospective, multi-center, randomized and controlled studies in this subject, and standard or normal screening and treatment procedures have not yet been established in China. From this point, the investigators developed the Chinese people-specific procedures and standards of diagnosis of PFO-induced migraine in this study, based on current standards and methods of diagnosis, treatment and prevention of PFO-induced migraine in foreign countries. And the investigators prospectively adopted continuous inclusion of the high-risk patients with PFO-induced migraine, who were randomly divided into the closure treatment (transcatheter closure of PFO) group and the medication (drugs administered alone) group at the ratio of 1:1., in order to evaluate if the interventional treatment is better than the medication alone in these patients, to assess the efficacy and safety of the made-in-China occluders in the interventional treatment and prevention of PFO-induced migraine, and to identify the incidence of PFO in the patients with migraine in China and develop the Chinese people-specific screening protocols of PFO-induced migraine.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: June 2018
• Est. primary completion date: January 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 60 Years

Eligibility

Inclusion Criteria:

• migraine headaches with or without aura,migraine onset before age 50

• >3 migraine attacks or 5 migraine days per month

• failed =2 commonly accepted migraine medications:ß-receptor blockers, calcium-ion antagonists, antidepressants and non-steroid anti-inflammatory drugs (NSAID).

• PFO documented by TTE or TEE

• PFO meet one of the following conditions:RLS in rest documented by cTTE or cTCD,combine with ASA,the primary patition mobility=6.5mm,the diameter of PFO=4mm, combine with Eustachian Valve or Chiari net.

• age 18-60

• else:independent in daily activities,to comply with complete follow-up experiment design

Exclusion Criteria:

• contraindication to antiplatelet or anticoagulant

• inferior vena cava or pelvic vein thrombogenesis leading to complete obstruction,systemic or local infection,septicemia,heart lumen thrombosis

• pregnancy

• combine with pulmonary hypertension or PFO made for a particular channel

• severe allergy to nickel

Related Conditions & MeSH terms

• Foramen Ovale, Patent
• Headache
• Migraine Disorders
• Patent Foramen Ovale

Intervention

Procedure:
• the transcatheter closure of PFO
the transcatheter closure of PFO was performed using the made-in-China occluders approved by SFDA,clopidogrel(50mg/d, 3mon) , aspirin (0.1g/d, 6mon), i.e. oral administration of aspirin (0.1g/d) and clopidogrel (50mg/d) at 48h before the closure; the low molecular weight heparin (LMWH) was routinely given at 48h after the closure; and some pain-relief drugs could be temporarily administered in the patients with acute onset of migraine.

Locations

Country	Name	City	State
China	First Affiliated Hospital of Xian JiaotongUniversity	Xi'an	Shaanxi

Sponsors (4)

Lead Sponsor	Collaborator
First Affiliated Hospital Xi'an Jiaotong University	Fourth Military Medical University, Second Affiliated Hospital of Xi'an Jiaotong University, Southwest Hospital, China

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	migraine days after randomization		up to 1 year