Related Experiment Video

Updated: May 21, 2026

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

Patent foramen ovale and ischemic stroke

V Larrue1, P Massabuau

  • 1Department of Neurology, University of Toulouse, Toulouse, France. larrue.v@chu-toulouse.fr

Minerva Medica
|June 2, 2012
PubMed

Insights

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.

More Related Videos

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure07:41

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Published on: February 8, 2022

Related Concept Videos

Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Ischemic Heart Disease: Overview01:17

Ischemic Heart Disease: Overview

Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...