Patent Foramen Ovale Closure for Secondary Stroke Prevention

Patent foramen ovale (PFO) is a common congenital cardiac anomaly that may serve as a conduit for paradoxical embolism, potentially leading to ischemic stroke. Randomized controlled trials have demonstrated that PFO closure effectively reduces stroke recurrence, with particularly favorable outcomes in patients with high-risk PFO features such as a large shunt size or atrial septal aneurysm. However, real-world clinical data have shown inconsistent findings, raising concerns regarding the generalizability of these results. Additionally, post-procedural atrial fibrillation remains a significant issue and requires careful patient selection. While recent studies have refined the criteria for identifying patients most likely to benefit from PFO closure, direct comparisons between PFO closure and non-vitamin K antagonist oral anticoagulants (NOACs) remain lacking. Further research is required to optimize long-term management strategies and evaluate treatment outcomes across diverse patient populations.