To dig oneself into a hole or to dig the tunnel to the core? A study on the Swartz sheath support strategy for patent foramen ovale closure in migraine patients.

Closing a patent foramen ovale (PFO) can help migraine patients. However, small shunt PFOs present challenges for multipurpose angiographic catheters. This study introduces a new procedural approach using the Swartz sheath support strategy (SSSS). The research involved 285 patients with migraines and PFOs treated from January 2020 to December 2022. Among these patients, 82 (29%) underwent the SSSS. No complications arose in the SSSS group during surgery. The relief and cessation rates of headaches were similar in both groups. However, the SSSS group experienced a greater reduction in migraine burden. After adjusting for variables, no significant differences in migraine outcomes were found. Higher attack intensity and larger residual shunts were linked to migraine relief. The study concludes that the SSSS is a safe and effective method for PFO closure in migraine patients, improving symptoms after surgery. Clinical relevance: This research shows that the Swartz sheath support strategy can improve migraine outcomes for patients with difficult PFO closures.