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Updated: Jan 31, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Percutaneous closure of a patent foramen ovale after cryptogenic stroke
R J R Snijder1, M J Suttorp2, J M Ten Berg2
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. rj.snijder@antoniusziekenhuis.nl.
Insights
Patent foramen ovale closure is recommended for cryptogenic stroke patients under 55 with high-risk PFO. Recent trials show closure benefits over medical therapy alone.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Patent foramen ovale (PFO) is a common heart defect between the atria.
- PFO can lead to right-to-left shunting, increasing cryptogenic stroke risk.
- Previous studies yielded inconclusive results on PFO closure efficacy for stroke prevention.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous PFO closure versus medical therapy for cryptogenic stroke.
- To identify predictors of recurrent stroke events in patients with PFO.
Main Methods:
- Review of recent large prospective trials and long-term follow-up studies.
- Analysis of patient data, including shunt size and atrial septal aneurysm presence.
- Comparison of percutaneous PFO closure outcomes against standard medical therapy.
Main Results:
- Recent trials demonstrate a benefit of percutaneous PFO closure over medical therapy alone.
- Larger right-to-left shunts and atrial septal aneurysms predict recurrent stroke.
- PFO closure is particularly beneficial in younger patients (under 55) with high-risk PFO.
Conclusions:
- Percutaneous PFO closure should be considered for cryptogenic stroke patients under 55 with high-risk PFO.
- Closure offers a superior alternative to antiplatelet therapy alone in select patient groups.
- Identifying high-risk PFO features is crucial for guiding treatment decisions.
Abstract:
A patent foramen ovale is a common intracardiac finding that is located between the left and right atrium. It can cause right-to-left shunting and has a high prevalence in patients who suffer a cryptogenic stroke. Earlier trials did not show superiority of percutaneous patent foramen ovale closure with standard medical therapy over standard medical therapy alone in the treatment of cryptogenic stroke. Interestingly, several meta-analyses show positive results regarding closure, suggesting underpowering of the individual trials. Recently, two large prospective trials and one long-term follow-up study showed benefit of percutaneous closure over standard medical therapy in treatment of cryptogenic stroke. A larger right-to-left shunt or the presence of an atrial septal aneurysm were predictors for a recurrent event. Therefore, percutaneous patent foramen ovale closure after cryptogenic stroke should be recommended over antiplatelet therapy alone in patients younger than 55 years of age with a high-risk patent foramen ovale.
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