Patent Foramen Ovale in Patients with Neurologic Events: When, How, and Whom to Treat

Patent foramen ovale (PFO) is the commonest interatrial communication and a frequent, though often incidental, finding after cryptogenic stroke. Selecting whom to treat rests on causal attribution: the Risk of Paradoxic Embolism score and PFO-Associated Stroke Causal Likelihood classification identify the patients in whom closure works. Deciding when to treat sets the indication threshold, defines when to withhold closure, and requires excluding atrial fibrillation (AF) first. Treating well covers the procedure, device and antithrombotic strategy, and management of the AF trade-off. Uncertainty persists in patients aged more than 60 and in preclosure rhythm monitoring, where heart-brain team judgment matters most.