[Patent foramen ovale closure : update]

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Context:

• The management of recurrent ischemic stroke in patients with patent foramen ovale (PFO) remains a clinical challenge.
• Percutaneous PFO closure has emerged as a potential therapeutic option, but its efficacy compared to medical therapy requires careful consideration.
• Recent randomized trials provide crucial data on the comparative effectiveness of PFO closure versus medical management for specific patient subgroups.

Purpose:

• To summarize the current evidence and clinical considerations regarding percutaneous PFO closure for the prevention of recurrent ischemic stroke.
• To highlight the importance of a multidisciplinary approach in patient selection and decision-making for PFO closure.
• To discuss key factors influencing the indication for PFO closure, including PFO anatomy, neuroimaging findings, and thrombotic risk assessment.

Summary:

• Recent randomized trials demonstrate the superiority of percutaneous PFO closure over medical therapy in patients with large shunts and recurrent ischemic stroke.
• Patient selection for PFO closure is complex, necessitating a multidisciplinary team (neurologists, cardiologists, hematologists) to evaluate PFO anatomy, brain imaging, venous thromboembolism history, and thrombophilia.
• Systematic exclusion of atrial fibrillation (AF) is critical. While procedural complication rates are low, an increased incidence of AF post-closure compared to medical therapy warrants attention.

Impact:

• Provides clinicians with evidence-based guidance on the appropriate use of percutaneous PFO closure for stroke prevention.
• Emphasizes the need for individualized risk assessment and shared decision-making in managing patients with PFO and stroke.
• Informs future research directions, particularly concerning the long-term management of AF after PFO closure.