PFO Closure for Cryptogenic Stroke: Review of New Data and Results

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Opinion statement

Observational studies over 20 years have suggested that a patent foramen ovale (PFO) is an important cause of cryptogenic stroke in young individuals; case series and registries suggest that PFO closure confers superior protection from recurrent transient ischemic attack (TIA) and stroke. Recently completed randomized clinical trials did not confirm this hypothesis, but have provided reassurance that the risk of recurrent stroke is low at 1.5 %/yr. A target subset that may benefit are those with ischemic stroke, a large right-to-left shunt, and an atrial septal aneurysm. Further study is needed to determine the optimum strategy to reduce the long-term stroke risk in a lifetime of varying situational risk factors and temporary interruptions of medical therapies.