Why the study?
PFO and cryptogenic stroke both have a high prevalence, and the optimal treatment to reduce stroke recurrence after cryptogenic stroke remains controversial.
Does percutaneous PFO device closure and medical therapy reduce stroke recurrence in patients with patent foramen ovale and cryptogenic stroke?
Does percutaneous PFO device closure and medical therapy reduce stroke recurrence in patients with patent foramen ovale and cryptogenic stroke?
PFO closure combined with medical therapy is beneficial for secondary stroke prevention in selected patients with cryptogenic stroke, particularly those with high-risk anatomic features, though it carries a risk of incident atrial fibrillation.
May support PFO closure in selected high-risk patients; leaves open optimal selection and long-term AF monitoring.
Patent foramen ovale (PFO) and cryptogenic stroke (CS) both have a high prevalence. The optimal treatment to reduce stroke recurrence after CS remains controversial. Results from clinical trials, meta-analyses, and position papers, support percutaneous PFO device closure and medical therapy compared to medical therapy alone. However, the procedure may be associated with cardiac complications including an increased incidence of new atrial fibrillation. The benefit/risk balance should be determined on a case-by-case basis with the greatest benefit of PFO closure in patients with atrial septal aneurysm and PFO with large shunts. Future studies should address unsolved questions such as the choice of medical therapy in patients not undergoing closure, the duration of antiplatelet therapy, and the role of PFO closure in patients over 60 years old.
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Parrini et al. (2020) studied this question.
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