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Updated: Jun 6, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Patent Foramen Ovale (PFO): History, Diagnosis, and Management
Aurel Maloku1, Ali Hamadanchi1, Albrecht Günther2
1Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, 07747 Jena, Germany.
Insights
Patent foramen ovale (PFO) closure is recommended for select stroke patients. Device closure shows promise for stroke prevention, with ongoing research into other applications like migraines.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Patent foramen ovale (PFO) is a potential risk factor for cryptogenic stroke.
- Current guidelines recommend PFO closure for specific high-risk stroke patients aged 16-60.
- PFO closure is an established interventional cardiology procedure.
Purpose of the Study:
- To review the efficacy and procedural aspects of patent foramen ovale closure.
- To evaluate the number needed-to-treat (NNT) for stroke prevention via PFO closure.
- To discuss the current evidence and considerations for PFO closure in stroke patients.
Main Methods:
- Analysis of data from key clinical trials (CLOSE, RESPECT, REDUCE).
- Review of interventional PFO closure techniques and devices.
- Assessment of complication risks and post-procedural management.
Main Results:
- NNT for stroke recurrence prevention varies: 20-44 (5 years) in CLOSE/RESPECT, 28 (2 years) and 18 (10 years) in REDUCE.
- Interventional PFO closure is technically feasible but requires meticulous technique.
- Antiplatelet therapy is standard post-closure.
Conclusions:
- PFO closure is effective in reducing stroke recurrence in selected patients.
- The procedure is generally safe but necessitates careful execution.
- Evidence for PFO closure in conditions beyond stroke, like migraines, requires further investigation.
Abstract:
Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. Other trials, such as the REDUCE trial, presented much better data with a NNT of 28 at two years and as low as 18 over a follow-up period of 10 years. Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. Usually, a double-disk occlusion device is used, followed by antiplatelet therapy. While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.
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