Ischemic Attacks and Patent Foramen Ovale: Transcatheter Closure of Patent Foramen Ovale in Adults with Cryptogenic Systemic Embolism

Abstract

In the presence of a patent foramen ovale with otherwise unexplained (cryptogenic) cerebral embolism, the usual therapy is oral anticoagulation or antiplatelet therapy. Surgery is considered only in cases of recurrence. Percutaneous transcatheter occlusion of the patent foramen ovale (PFO) is a new valuable alternative. This article presents the current knowledge and our data concerning nonsurgical closure of patent foramen ovale to prevent paradoxical arterial embolism. Transcatheter PFO closure represents an elegant therapeutic approach in patients with suspected paradoxical embolism because it avoids open heart surgery and is minimally invasive. Even if the recurrence rate of embolism were identical, transcatheter closure would be preferable to anticoagulation because the annual risk of bleeding complications of 2%‐3% and the long‐term costs of anticoagulation can be avoided. Randomized studies are needed to compare transcatheter closure of patent foramen ovale with anticoagulation, platelet inhibitors, or surgery.