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Updated: Feb 19, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Device closure for patent foramen ovale following cryptogenic stroke: a survey of current practice in the UK
Katherine Von Klemperer1, Aleksander Kempny1, Christopher William Pavitt2
1Grown up Congenital Heart Disease Centre, Barts Heart Centre, London, UK.
Insights
Patent foramen ovale (PFO) closure for cryptogenic stroke is supported by most UK specialists. However, current practice varies significantly between cardiologists and stroke physicians/neurologists regarding patient selection and post-procedure care.
Area of Science:
- Cardiology and Neurology
- Interventional Cardiology
- Stroke Medicine
Background:
- Patent foramen ovale (PFO) closure for cryptogenic stroke is debated due to limited randomized controlled trial data.
- National and international guidelines offer differing recommendations on PFO closure indications.
- Specialist interpretation of evidence and current UK practice for PFO closure in cryptogenic stroke require clarification.
Purpose of the Study:
- To survey UK cardiologists, stroke physicians, and neurologists on their interpretation of PFO closure evidence.
- To gain insight into current UK practice regarding PFO closure for cryptogenic stroke.
- To identify factors influencing specialist decisions on PFO closure and post-procedure management.
Main Methods:
- An online survey was distributed to UK cardiologists, stroke physicians, and neurologists via the British Cardiac Society and British Society of Stroke Physicians.
- 120 physicians (70 stroke physicians, 23 neurologists, 27 cardiologists) completed the survey.
- Survey questions addressed specialist views on PFO closure indications, exclusion criteria, anatomical features, multidisciplinary discussion, and post-closure therapy.
Main Results:
- 89% of physicians believe PFO closure should be considered in selected cryptogenic stroke patients.
- Commonly cited exclusion criteria include atrial fibrillation, significant carotid stenosis, diabetes, and hypertension.
- Significant differences were observed in age cut-off considerations, preference for multidisciplinary meetings, and duration of post-closure therapy between cardiologists and stroke physicians/neurologists.
Conclusions:
- UK experts generally support selective PFO closure for cryptogenic stroke.
- Current clinical practice demonstrates considerable variability, particularly concerning patient selection and management strategies.
- Discrepancies in perceptions between cardiologists and neurologists/stroke physicians highlight the need for practice standardization.
Abstract:
Patent foramen ovale (PFO) closure for cryptogenic stroke remains controversial due to a lack of conclusive randomised controlled data. Many experts feel PFO closure is indicated in selected cases; however, national and international guideline recommendations differ. We surveyed the UK cardiologists, stroke physicians and neurologists, seeking to determine specialist interpretation of the evidence base, and to gain an insight into the current UK practice. The British Cardiac Society and British Society of Stroke physicians distributed our survey which was performed using an online platform. 120 physicians (70 stroke physicians, 23 neurologists, 27 cardiologists) completed the survey. Most (89%) felt PFO closure should be considered in selected patients. Atrial fibrillation (86.6%), significant carotid stenosis (86.6%), diabetes (38.4%) and hypertension (36.6%) were considered exclusion criteria for cryptogenic stroke diagnosis. More stroke physicians than cardiologists considered an age cut-off when considering PFO as the stroke aetiology (70.4%vs 54.5%p=0.04). Anatomical features felt to support PFO closure were aneurysmal septum (89.6%), shunt size (73.6%), prominent Eustachian valve (16%). 60% discuss patients in multidisciplinary meetings prior to PFO closure, with more cardiologists than stroke physicians/neurologists favouring this approach (76.9% vs 54.8%; p=0.05). After PFO closure, patients receive Clopidogrel (72.3%), aspirin (50%) or anticoagulants (17%). 63.2% continue therapy for a limited period after PFO closure, while 34% prefer life-long therapy (14.8% cardiologists vs 40.5% non-cardiologists; p=0.02). While experts support selective PFO closure in cryptogenic stroke, current practice remains variable with significant differences in perceptions of cardiologists and neurologists/stroke physicians.
