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Stroke Prevention in Patients with Patent Foramen Ovale

  • Stroke (DL Tirschwell, Section Editor)
  • Published:
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Abstract

Purpose of Review

Patent foramen ovale (PFO) is widely prevalent and studies have suggested an association with ischemic stroke. In this review, we aim to highlight current management of patients with ischemic stroke in the setting of PFO and discuss some areas of controversy.

Recent Findings

Upon reviewing the literature, we have found that the evidence regarding the management of patients with cryptogenic stroke and PFO has come a long way in the past several years, and many uncertainties remain in clinical practice. The Risk of Paradoxical Embolism (RoPE) score helps to predict the probability of a pathogenic PFO, and recent trial data confirms the benefit of closure in carefully selected patients. The benefit of closure in older patients and in patients with alternate, competing mechanisms is still uncertain, and the long-term risks of closure are not known. Finally, the efficacy of direct oral anticoagulants (DOACs) in this patient population as compared to other medical therapy or mechanical closure has not yet been investigated. Randomized data is needed to help answer these questions.

Summary

PFO closure is a safe and effective strategy in reducing stroke risk in carefully selected patients with cryptogenic stroke in the setting of a PFO. More studies are needed to test optimal medical treatment strategies and the safety and efficacy of PFO closure in patient subgroups not included in prior PFO closure trials.

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Authors and Affiliations

  1. Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA

    Alison Thaler, Alexandra Kvernland & Sean Kelly

  2. Department of Internal Medicine, Brown University, Providence, RI, USA

    Christopher Song

  3. Department of Neurology, Boston University, Boston, MA, USA

    Hugo J. Aparicio

  4. Department of Neurology, Boston Medical Center, Boston, MA, USA

    Hugo J. Aparicio

  5. Department of Neurology, Duke University, Durham, NC, USA

    Brian Mac Grory

  6. Department of Neurology, Brown University, 593 Eddy Street APC 5, Providence, RI, 02903, USA

    Shadi Yaghi

Authors
  1. Alison Thaler
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  2. Alexandra Kvernland
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  3. Sean Kelly
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  4. Christopher Song
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  5. Hugo J. Aparicio
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  6. Brian Mac Grory
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  7. Shadi Yaghi
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Correspondence to Shadi Yaghi.

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Thaler, A., Kvernland, A., Kelly, S. et al. Stroke Prevention in Patients with Patent Foramen Ovale. Curr Cardiol Rep 23, 183 (2021). https://doi.org/10.1007/s11886-021-01605-0

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  • DOI: https://doi.org/10.1007/s11886-021-01605-0

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