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Updated: Dec 29, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Updates in the Management of Cryptogenic Stroke and Patent Foramen Ovale
David K Stone1, Natalie Buchwald, Christina A Wilson
1First Physicians Group of Sarasota Memorial Health Care System (DKS), Sarasota, Florida; and Department of Neurology (NB, CAW), University of Florida, Gainesville, Florida.
Insights
Identifying the cause of stroke is crucial for preventing future events. This review examines stroke mechanisms, including patent foramen ovale (PFO), and optimal treatments for secondary stroke prevention.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Stroke is a prevalent neurological disorder often presenting with visual disturbances.
- Comprehensive evaluation is essential for identifying stroke causes and optimizing secondary prevention strategies.
- In some cases, a high-risk mechanism for stroke remains unidentified despite thorough investigation, necessitating further research into optimal management.
Purpose of the Study:
- To compare cryptogenic stroke with embolic stroke of undetermined source.
- To summarize common causes of these strokes.
- To review evidence for optimal antithrombotic management and the role of patent foramen ovale (PFO) closure.
Main Methods:
- An evidence-based literature review was conducted using PubMed and published stroke guidelines.
Main Results:
- The review compares cryptogenic stroke and embolic stroke of undetermined source.
- Common underlying causes and optimal antithrombotic management strategies are summarized.
- Recent clinical trials supporting percutaneous PFO closure for secondary stroke prevention in specific patient groups are discussed.
Conclusions:
- Stroke management requires individualized risk factor assessment.
- Vascular neurologist-directed evaluation and treatment are key for optimal secondary prevention, particularly when etiology is unclear.
Background:
Stroke is a common neurological disorder and may present with visual symptoms. A thorough workup is warranted to determine the underlying cause of stroke to optimize secondary prevention. Despite a full workup, a high-risk mechanism may not be identified. Optimal treatment in this patient population has been the subject of recent research, particularly with regard to low-risk stroke mechanisms such as patent foramen ovale (PFO).
Evidence Acquisition:
Using PubMed and published stroke guidelines, an evidence-based literature review was performed.
Results:
In this review, we compare cryptogenic stroke with the newer concept of embolic stroke of undetermined source, summarize the most common causes presumed to underlie these strokes, and review the evidence for optimal antithrombotic management. We also review recent clinical trials demonstrating a benefit for percutaneous closure of PFO for secondary stroke prevention in select patients.
Conclusions:
Stroke management is based on evaluation of individual patient-risk factors. Evaluation and treatment is ideally directed by a vascular neurologist to ensure optimal secondary prevention, especially in cases where an underlying etiology is not identified on initial workup.
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