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Updated: Nov 16, 2025
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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
4.5K
Advances and ongoing controversies in PFO closure and cryptogenic stroke
Tiffany Cheng1, Joaquin B Gonzalez2, Fernando D Testai1
1Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States.
Handbook of Clinical Neurology
|February 26, 2021
Summary
Patent foramen ovale (PFO) closure may prevent recurrent strokes in select cryptogenic stroke patients. Evidence supports PFO closure over medical treatment in young patients, but broader population benefits require further study.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Cryptogenic stroke (CS) accounts for about one-third of all strokes.
- Patent foramen ovale (PFO) is more prevalent in CS patients than in those with known stroke origins.
- Paradoxical embolism across a PFO is a proposed mechanism for some CS.
Purpose of the Study:
- To review the evidence for patent foramen ovale (PFO) closure in preventing recurrent cryptogenic strokes (CS).
- To discuss patient selection criteria for PFO closure intervention.
Main Methods:
- Review of existing randomized clinical trials and scientific literature.
- Analysis of data comparing medical treatment versus transcatheter PFO closure for CS prevention.
- Evaluation of patient characteristics influencing treatment outcomes.
Main Results:
- Transcatheter PFO closure demonstrated superiority over medical treatment in preventing recurrent stroke in young CS patients.
- Evidence for PFO closure superiority in unselected CS populations is not yet established.
- Patient selection is crucial for optimizing outcomes of PFO closure.
Conclusions:
- Transcatheter PFO closure is a viable option for select patients with cryptogenic stroke, particularly younger individuals.
- Further research is needed to define optimal patient selection for PFO closure in broader populations.
- Understanding the role of PFO in CS is critical for guiding therapeutic strategies.
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