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Updated: May 10, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Management of patients with patent foramen ovale and cryptogenic stroke: a collaborative, multidisciplinary, position
Christian Pristipino1, Gian Paolo Anzola, Luigi Ballerini
1Clinical Research Centre and Cardiovascular Department, San Filippo Neri Hospital, Roma, Italy. pristipino.c@gmail.com
Insights
This consensus statement provides a unified approach for managing patent foramen ovale (PFO) and cryptogenic stroke, offering guidance for specialists. It aims to standardize care for patients with PFO and stroke, improving outcomes.
Area of Science:
- Cardiology
- Neurology
- Hematology
Background:
- Management of patent foramen ovale (PFO) and cryptogenic stroke remains controversial.
- There's a noted increase in interventional closure procedures for PFO.
Purpose of the Study:
- To establish a unified management strategy for patent foramen ovale (PFO) and cryptogenic stroke.
- To facilitate a shared approach among cardiologists, neurologists, and hematologists.
Main Methods:
- A consensus statement was developed through collaboration between Italian national scientific societies.
- Task force members from relevant societies contributed to drafting and revising the guidelines.
- A multi-step review process ensured widespread expert input and final approval.
Main Results:
- Clear definitions for transient ischemic attack and cryptogenic strokes were established.
- A diagnostic workup was outlined to determine PFO's role in stroke pathogenesis.
- Recommendations for medical and interventional therapies, considering recurrence risk, were provided.
Conclusions:
- The developed guidelines offer a basis for a shared approach to managing cryptogenic stroke and PFO in Italy.
- International collaboration is encouraged to further advance PFO and stroke management strategies.
Objectives:
To organize a common approach on the management of patent foramen ovale (PFO) and cryptogenic stroke that may be shared by different specialists.
Background:
The management of PFO related to cryptogenic stroke is controversial, despite an increase in interventional closure procedures.
Methods:
A consensus statement was developed by approaching Italian national cardiological, neurological, and hematological scientific societies. Task force members were identified by the president and/or the boards of each relevant scientific society or working group, as appropriate. Drafts were outlined by specific task force working groups. To obtain a widespread consensus, these drafts were merged and distributed to the scientific societies for local evaluation and revision by as many experts as possible. The ensuing final draft, merging all the revisions, was reviewed by the task force and finally approved by scientific societies.
Results:
Definitions of transient ischemic attack and both symptomatic and asymptomatic cryptogenic strokes were specified. A diagnostic workout was identified for patients with candidate event(s) and patient foramen ovale to define the probable pathogenesis of clinical events and to describe individual PFO characteristics. Further recommendations were provided regarding medical and interventional therapy considering individual risk factors of recurrence. Finally, follow-up evaluation was appraised.
Conclusions:
Available data provided the basis for a shared approach to management of cryptogenic ischemic cerebral events and PFO among different Italian scientific societies. Wider international initiatives on the topic are awaited.
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