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Updated: May 21, 2026
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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Patent foramen ovale and ischemic stroke.
1Department of Neurology, University of Toulouse, Toulouse, France. larrue.v@chu-toulouse.fr
Minerva Medica
|June 2, 2012
Summary
Patent foramen ovale (PFO) is common and usually benign. However, it may increase stroke risk, especially with atrial septal aneurysm (ASA), necessitating further research into optimal secondary prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Patent foramen ovale (PFO) is a frequent finding in healthy individuals, typically not linked to ischemic stroke risk in population studies.
- Conversely, case-control studies indicate a higher prevalence of PFO in cryptogenic stroke patients, suggesting a potential causal role.
- The association between PFO, atrial septal aneurysm (ASA), and stroke mechanisms remains unclear, with paradoxical embolism being rarely documented.
Purpose of the Study:
- To review the current understanding of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in the context of cryptogenic stroke.
- To discuss the uncertainties surrounding the mechanisms of stroke associated with PFO/ASA.
- To evaluate the current and debated treatment strategies for secondary prevention in patients with cryptogenic stroke and PFO.
Main Methods:
- Literature review and synthesis of findings from population-based cohort studies, case-control studies, and randomized controlled trials.
- Analysis of the evidence regarding stroke risk, recurrence, and potential mechanisms related to PFO and ASA.
- Evaluation of existing and proposed secondary prevention treatments, including medical therapy and device closure.
Main Results:
- While PFO is common and not typically associated with stroke risk, its prevalence is higher in cryptogenic stroke cases.
- Stroke recurrence risk in PFO patients with cryptogenic stroke is low with aspirin but may increase with ASA.
- A randomized trial did not show transcatheter PFO closure to be superior to medical therapy.
Conclusions:
- The role of PFO in cryptogenic stroke requires further investigation, particularly concerning its interaction with ASA.
- Optimal secondary prevention for cryptogenic stroke patients with PFO remains uncertain and debated.
- Future randomized controlled trials are needed to compare anticoagulation with aspirin and to further elucidate PFO closure efficacy.
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