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Updated: Oct 16, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Coronary Artery Disease in Adults Undergoing Percutaneous Patent Foramen Ovale Closure Following Cryptogenic Stroke
Claudia Frankfurter, Annamalar M Muthuppalaniappan, Ricardo Gorocica-Romero
1Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4. eric.horlick@uhn.ca.
Insights
Coronary angiography is not routinely needed for patients with cryptogenic stroke undergoing patent foramen ovale (PFO) closure. This study found a low prevalence of coronary artery disease (CAD) in this patient group.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Patent foramen ovale (PFO) is common in cryptogenic stroke patients.
- Guidance on coronary angiography during PFO closure is limited.
- Characterizing coronary artery disease (CAD) in this population is crucial.
Purpose of the Study:
- To determine the prevalence of CAD in patients with cryptogenic stroke undergoing percutaneous PFO closure.
- To assess the necessity of routine coronary angiography in this cohort.
Main Methods:
- Retrospective analysis of 180 patients aged 40+ with cryptogenic stroke and no known CAD.
- Concurrent percutaneous PFO closure and coronary angiography.
- Visual analysis of coronary angiograms.
Main Results:
- Low prevalence of CAD: 4% severe, 8% moderate, 18% mild.
- 5% had moderate-to-severe proximal or multivessel disease.
- Further management varied, with most medically managed or risk-stratified.
Conclusions:
- Coronary angiography identified a low prevalence of CAD in patients undergoing PFO closure for cryptogenic stroke.
- Routine coronary angiography may not be indicated in this specific patient population.
- Further research could refine indications for angiography in PFO closure patients.
Background:
A patent foramen ovale (PFO) is found in nearly half of patients with cryptogenic stroke. Little guidance on the use or necessity of coronary angiography at the time of percutaneous PFO closure exists. We aimed to characterize the presence of coronary artery disease (CAD) in patients undergoing PFO closure following a cryptogenic stroke.
Methods:
A retrospective analysis of consecutive patients who underwent concurrent percutaneous PFO closure and coronary angiography was performed. Patients were ≥40 years of age and had a preceding diagnosis of cryptogenic stroke with no known CAD. Visual analysis of coronary angiograms was performed.
Results:
Of 180 patients, 8 (4%) had severe CAD, 15 (8%) had moderate CAD, 32 (18%) had mild CAD, and 12 (7%) had luminal irregularities. Of those with moderate-to-severe CAD, 9 (5%) had proximal disease and 9 (5%) had multivessel disease. Of those with moderate-to-severe CAD, 8 (35%) underwent further risk stratification with stress testing, 4 (17%) were medically managed, and 1 (4%) underwent concurrent angioplasty.
Conclusions:
Coronary angiography identified a low prevalence of CAD in patients with cryptogenic stroke undergoing PFO closure, suggesting that coronary angiography is not routinely indicated in patients undergoing PFO closure.
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