Patent foramen ovale percutaneous closure for transient ischemic attack versus ischemic stroke

Background Data regarding the benefit of patent foramen ovale (PFO) closure in patients with PFO-related transient ischemic attack (TIA), as compared with ischemic stroke, remain limited. Purpose To compare clinical outcomes after PFO closure according to the type of index cerebrovascular event (stroke ± TIA vs. isolated TIA). Methods We included patients who underwent PFO closure for secondary prevention of stroke or TIA in the international AIR FORCE registry across 31 centers in France, Italy, and the Netherlands between 2001 and 2025. The primary endpoint was the occurrence of center-reported stroke, TIA, or peripheral arterial embolism during follow-up. Cumulative incidence up to 3 years was estimated using Kaplan–Meier methods, and associations between indication for PFO closure (TIA vs. ischemic stroke) and outcomes were assessed over the entire follow-up using adjusted Cox proportional hazards models. Results A total of 4672 patients were included. Baseline characteristics are presented in Table 1. After a median follow-up of 1.0 years [0.1–2.8], no significant association was observed between the indication for PFO closure and the composite outcome (aHR 1.52, 95% CI 0.83–2.77), with corresponding 3-year risks of 4.12% [2.08–8.08] in patients with only TIA and 1.80% [1.28–2.52] in patients with prior stroke (figure 1). Similarly, no significant association was observed for stroke or peripheral arterial embolism (aHR 0.73, 95% CI 0.26–2.04). In contrast, a significant association was observed for TIA recurrence (aHR 3.49, 95% CI 1.68–7.27), with higher 3-year risks in patients with only TIA (3.62% [1.71–7.59] vs. 0.72% [0.41–1.25]). Conclusion In this large international registry, the risk of stroke, TIA, or peripheral arterial embolism after PFO closure did not differ between patients with a PFO-related TIA versus those with a PFO-related stroke as the index event. However, patients with index TIA had a significantly higher risk of TIA recurrence, suggesting the involvement of other causes.