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Updated: Feb 8, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
[Patent foramen ovale-intervention or pharmaceutical treatment]
C Liebetrau1,2,3, C W Hamm4,5
1Abteilung Kardiologie, Kerckhoff Herz und Thorax Zentrum, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland. c.liebetrau@kerckhoff-klinik.de.
Insights
Interventional closure of patent foramen ovale (PFO) significantly reduces recurrent stroke risk in younger patients (<60 years) compared to medication alone. PFO closure is safe and effective for cryptogenic stroke patients.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Patent foramen ovale (PFO) is found in 40-50% of cryptogenic stroke patients.
- Atrial septal aneurysm increases stroke risk in PFO patients.
Purpose of the Study:
- To review evidence for interventional PFO closure in cryptogenic stroke.
- To outline diagnostic criteria and indications for PFO intervention.
- To discuss antiplatelet and anticoagulant therapies.
Main Methods:
- Analysis of recent randomized trials (CLOSE, REDUCE, DEFENSE-PFO) and RESPECT study follow-up.
- Comparison of interventional PFO closure versus pharmaceutical treatment.
- Evaluation of benefits and risks of different treatment strategies.
Main Results:
- Interventional PFO closure is superior to pharmaceutical treatment alone for cryptogenic stroke patients under 60.
- A significant reduction in recurrent stroke incidence was observed with PFO closure.
- The complication rate associated with PFO closure is very low.
Conclusions:
- Younger patients (<60 years) with cryptogenic stroke and PFO experience the greatest benefit from interventional closure.
- Interventional PFO closure offers a favorable risk-benefit profile for select patients.
Background:
Approximately 40-50% of patients with cryptogenic stroke have a patent foramen ovale (PFO). A concomitant atrial septal aneurysm aggravates the risk of recurrent stroke.
Objective:
The most important changes regarding the evidence for interventional closure of a PFO in patients with cryptogenic stroke are described. This includes the prerequisites for making a diagnosis and the indications for interventional treatment. The article also provides an overview about platelet aggregation inhibitor treatment with and without oral anticoagulation.
Current Data:
The balance between benefits and risks of interventional versus pharmaceutical treatment in patients with cryptogenic stroke and PFO has so far not been sufficiently proven. In 2017 two prospective randomized trials (CLOSE and REDUCE) and the long-term follow-up results of the RESPECT study were published, followed by the results of the DEFENSE-PFO study in 2018. A better assessment of the weighing up of the treatment options can now be made. All four studies showed that the interventional treatment of PFO is superior to pharmaceutical treatment alone for patients with cryptogenic stroke under 60 years of age.
Conclusion:
There was a significant reduction in the incidence of recurrent stroke in patients with interventional PFO closure compared with pharmaceutical treatment. The complication rate of PFO closure is very low and younger patients (<60 years) in particular benefit from PFO closure.
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