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Updated: Nov 15, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Device closure for patent foramen ovale in patients with cryptogenic stroke: which patients should get it?
Iris Parrini1, Enrico Cecchi2, Davide Forno2
1Division of Cardiology, Mauriziano Hospital Turin, Italy.
Insights
Percutaneous patent foramen ovale (PFO) closure combined with medical therapy may reduce stroke recurrence in cryptogenic stroke (CS) patients. However, potential cardiac complications necessitate individualized treatment decisions.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Patent foramen ovale (PFO) and cryptogenic stroke (CS) are common conditions.
- Optimal treatment strategies to prevent recurrent CS remain debated.
- Current evidence suggests PFO closure may be beneficial, but risks exist.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous PFO device closure for secondary stroke prevention.
- To compare outcomes of PFO closure plus medical therapy versus medical therapy alone.
- To identify patient subgroups who may benefit most from PFO closure.
Main Methods:
- Review of clinical trials, meta-analyses, and position papers.
- Analysis of data comparing PFO closure plus medical therapy with medical therapy alone.
- Assessment of procedural risks, including new-onset atrial fibrillation.
Main Results:
- Percutaneous PFO closure with medical therapy shows promise in reducing stroke recurrence compared to medical therapy alone.
- Patients with atrial septal aneurysm and large shunts may experience the greatest benefit.
- An increased incidence of new atrial fibrillation is a potential complication.
Conclusions:
- The benefit-risk balance of PFO closure must be individualized.
- Further research is needed on optimal medical therapy, antiplatelet duration, and PFO closure in older adults (>60 years).
Abstract:
Patent foramen ovale (PFO) and cryptogenic stroke (CS) both have a high prevalence. The optimal treatment to reduce stroke recurrence after CS remains controversial. Results from clinical trials, meta-analyses, and position papers, support percutaneous PFO device closure and medical therapy compared to medical therapy alone. However, the procedure may be associated with cardiac complications including an increased incidence of new atrial fibrillation. The benefit/risk balance should be determined on a case-by-case basis with the greatest benefit of PFO closure in patients with atrial septal aneurysm and PFO with large shunts. Future studies should address unsolved questions such as the choice of medical therapy in patients not undergoing closure, the duration of antiplatelet therapy, and the role of PFO closure in patients over 60 years old.
