Abstract
Patent foramen ovale (PFO) is a common cardiac anatomic variant that has been increasingly found in young (<60 years) cryptogenic stroke patients. Despite initial neutral randomized-controlled clinical trials (RCTs), there have been four recent RCTs providing consistent data in favor of the efficacy and safety of PFO closure compared to medical therapy for secondary stroke prevention. However, taking into consideration the high prevalence of PFO, the low risk of stroke recurrence under medical treatment and the uncommon yet severe adverse events of the intervention, patient selection is crucial for attaining meaningful clinical benefits. Thorough workup to exclude alternative causes of stroke and identification of high-risk PFOs through clinical, neuroimaging and echocardiographic criteria are essential. Cost effectiveness of the procedure cannot be proven for the time being, since there are no robust data on clinical outcome after PFO-associated stroke but only limited anecdotal data suggesting low risk for long-term disability.
Highlights
Foramen ovale is a component of the fetal cardiovascular circulation that during postnatal life closes in ≈70% of subjects, whereas in the remaining 30%, remains patent as a tunnel and converts into a “flap-like” valve that may open every time the right atrial pressure overcomes the left one
Patent foramen ovale (PFO) represents a potential source of cerebral embolism in subgroup of cryptogenic stroke patients and its mere presence in patients with ischemic stroke is insufficient to prove causality
Multiple recent randomized-controlled clinical trials (RCTs) have established the role of PFO closure in cryptogenic stroke patients 60 years old or younger
Summary
Foramen ovale is a component of the fetal cardiovascular circulation that during postnatal life closes in ≈70% of subjects, whereas in the remaining 30%, remains patent as a tunnel and converts into a “flap-like” valve that may open every time the right atrial pressure overcomes the left one. The PC trial randomized cryptogenic stroke/TIA patients younger than 60 to medical treatment with either antithrombotic or anticoagulation, or to PFO closure with a disk device [26].
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