Key result
PFO closure reduces recurrent stroke vs. medical therapy, but non-stroke indications remain uncertain.
Why the study?
While PFO closure reduces stroke recurrence in select patients with PFO-associated left circulation thromboembolism, the long-term benefits and risks in various clinical conditions remain uncertain.
Supports PFO closure for recurrent stroke prevention in high-risk patients; extends follow-up data but leaves non-stroke indications uncertain.
Persistent foramen ovale (PFO) is a congenital heart disease which represents 80% of atrial septal defects. It is a remnant of fetal circulation that functions in postnatal conditions as a transient interatrial right‑to‑‑left shunt of variable magnitude. Persistent foramen ovale may be implicated in the pathogenesis of several medical conditions, such as cryptogenic stroke, cryptogenic left circulation thromboembolism, migraine syndromes, and decompression sickness. The most frequent indication for PFO closure remains PFO‑associated left circulation thromboembolism. In select patients, PFO closure reduces stroke recurrence in comparison with medical therapy after more than 3 years of follow‑up on average, especially in patients with a high risk of recurrence. While in PFO‑associated left circulation embolism, there is now conclusive evidence on the growing benefit of PFO closure in long‑term follow‑up, in many other clinical conditions, the degree of certainty of the results is deceiving. In this paper, we will review the benefits and risks that one can expect in the long term after percutaneous PFO closure in various clinical scenarios in order to facilitate therapeutic decision making.
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Pristipino et al. (2021) conducted a review in Patent foramen ovale (PFO)-associated diseases (cryptogenic stroke, decompression sickness, migraine, arterial deoxygenation syndromes). Percutaneous persistent foramen ovale (PFO) closure vs. Medical therapy was evaluated. Percutaneous closure of persistent foramen ovale demonstrates a conclusive long-term benefit in reducing recurrent stroke compared with medical therapy, but evidence remains uncertain for its use in migraine, decompression sickness, and desaturation syndromes.
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