Key result
Patent foramen ovale closure reduces the risk of recurrent stroke in carefully selected young cryptogenic stroke patients, with an annualized risk reduction of ~0.6%.
Why the study?
Recent data have changed the landscape of PFO closure for secondary stroke prevention, prompting a synthesis of data and a framework for optimal management of stroke patients with PFO.
Does PFO closure reduce recurrent stroke in young cryptogenic stroke patients?
Does PFO closure reduce recurrent stroke in young cryptogenic stroke patients?
Absolute Risk Reduction: 0.6
Absolute Risk Reduction: 0.6%
PFO closure provides a small but impactful absolute risk reduction for recurrent stroke in carefully selected young patients with cryptogenic stroke, though it carries a small risk of procedural complications and atrial fibrillation.
Supports selective use in young cryptogenic stroke; leaves open optimal selection criteria and long-term outcomes.
PURPOSE OF REVIEW: Recent data have changed the landscape of patent foramen ovale (PFO) closure for secondary stroke prevention. This review synthesizes the data and provides a framework for optimal management of stroke patients with PFO. RECENT FINDINGS: The cumulative evidence indicates that PFO closure reduces the risk of recurrent stroke in carefully selected young cryptogenic stroke patients, with an annualized risk reduction of ∼0.6%. The benefit of PFO closure is particularly evident in patients with embolic appearing strokes, large right-to-left shunt, or an associated atrial septal aneurysm. There may be little or no benefit in patients with small deep infarcts, a small PFO, or an indication for long-term anticoagulation. Closure is accompanied by a small risk of major procedural complication and atrial fibrillation. SUMMARY: The annual risk of stroke from PFO is low relative to other stroke mechanisms, but the life-time cumulative risk in young patients who have experienced a prior stroke may be substantial, in which case the absolute benefit of closure is likely impactful. PFO is highly prevalent in the general population, present in about one in four adults, and should not be considered to be the cause of the stroke until a thorough workup has excluded alternative mechanisms.
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Favilla et al. (2019) conducted a review in Cryptogenic stroke with patent foramen ovale. Patent foramen ovale (PFO) closure was evaluated on Recurrent stroke (annualized risk reduction ~0.6%). Patent foramen ovale closure reduces the risk of recurrent stroke in carefully selected young cryptogenic stroke patients, with an annualized risk reduction of ~0.6%.
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