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Updated: Jun 24, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Device Closure or Antithrombotic Therapy After Cryptogenic Stroke in Elderly Patients With a High-Risk Patent Foramen
Pil Hyung Lee1, Jung-Sun Kim2, Jae-Kwan Song1
1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Percutaneous closure of patent foramen ovale (PFO) significantly reduces recurrent stroke and TIA in elderly patients. Device closure offers a promising intervention for this high-risk population.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Patent foramen ovale (PFO) is associated with stroke in younger patients.
- The efficacy of PFO closure in older patients (≥60 years) with cryptogenic stroke is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous PFO closure in preventing recurrent ischemic stroke or transient ischemic attack (TIA) in elderly patients.
Main Methods:
- A propensity-score matched analysis was conducted on patients aged ≥60 years with cryptogenic stroke and PFO.
- The study compared PFO closure plus medical therapy against medical therapy alone.
- Subgroup analysis included patients with high-risk PFO (atrial septal aneurysm or large shunt).
Main Results:
- PFO closure significantly reduced the composite risk of ischemic stroke or TIA in the overall matched cohort (HR: 0.45; P=0.012).
- In high-risk PFO patients, closure significantly lowered risks of both composite events (HR: 0.40; P=0.006) and ischemic stroke (HR: 0.47; P=0.035).
Conclusions:
- Elderly patients with cryptogenic stroke and PFO experience a high rate of recurrent events.
- Percutaneous PFO closure can significantly decrease the recurrence of ischemic stroke and TIA in this demographic.
Background And Purpose:
In young patients (aged 18-60 years) with patent foramen ovale (PFO)-associated stroke, percutaneous closure has been found to be useful for preventing recurrent ischemic stroke or transient ischemic attack (TIA). However, it remains unknown whether PFO closure is also beneficial in older patients.
Methods:
Patients aged ≥60 years who had a cryptogenic stroke and PFO from ten hospitals in South Korea were included. The effect of PFO closure plus medical therapy over medical therapy alone was assessed by a propensity-score matching method in the overall cohort and in those with a high-risk PFO, characterized by the presence of an atrial septal aneurysm or a large shunt.
Results:
Out of the 437 patients (mean age, 68.1), 303 (69%) had a high-risk PFO and 161 (37%) patients underwent PFO closure. Over a median follow-up of 3.9 years, recurrent ischemic stroke or TIA developed in 64 (14.6%) patients. In the propensity score-matched cohort of the overall patients (130 pairs), PFO closure was associated with a significantly lower risk of a composite of ischemic stroke or TIA (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.24-0.84; P=0.012), but not for ischemic stroke. In a subgroup analysis of confined to the high-risk PFO patients (116 pairs), PFO closure was associated with significantly lower risks of both the composite of ischemic stroke or TIA (HR: 0.40; 95% CI: 0.21-0.77; P=0.006) and ischemic stroke (HR: 0.47; 95% CI: 0.23-0.95; P=0.035).
Conclusion:
Elderly patients with cryptogenic stroke and PFO have a high recurrence rate of ischemic stroke or TIA, which may be significantly reduced by device closure.
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