Patent foramen ovale (PFO) and stroke: PFO closure

Benefits for PFO closure

• Many systematic reviews report that PFO closure reduces the risk of recurrent stroke
• The risk reduction has been calculated at 58%
• The outcomes are better if PFO closure is combined with antiplatelet therapy
• The highest benefit of PFO closure is in men and in people with large PFOs

Precautions before PFO closure

PFO closure techniques

Risks of PFO closure

Device-related PFO closure adverse events

References

1. Messe SR, Silverman IE, Kizer JR, et al. Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004; 62:1042-1050.
2. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-2236.
3. Mazzucco S, Li L, Binney L, Rothwell PM; Oxford Vascular Study Phenotyped Cohort. Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis. Lancet Neurol 2018; 17:609-617.
4. Ntaios G, Papavasileiou V, Sagris D, et al. Closure of patent foramen ovale versus medical therapy in patients with cryptogenic stroke or transient ischemic attack: updated systematic review and meta-analysis. Stroke 2018; 49:412-418. 
5. Garg L, Haleem A, Varade S, et al. Patent foramen ovale closure in the setting of cryptogenic stroke: a meta-analysis of five randomized trials. J Stroke Cerebrovasc Dis 2018; 27:2484-2493. 
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