Percutaneous closure of a patent foramen ovale after cryptogenic stroke

Abstract

A patent foramen ovale is a common intracardiac finding that is located between the left and right atrium. It can cause right-to-left shunting and has a high prevalence in patients who suffer a cryptogenic stroke. Earlier trials did not show superiority of percutaneous patent foramen ovale closure with standard medical therapy over standard medical therapy alone in the treatment of cryptogenic stroke. Interestingly, several meta-analyses show positive results regarding closure, suggesting underpowering of the individual trials. Recently, two large prospective trials and one long-term follow-up study showed benefit of percutaneous closure over standard medical therapy in treatment of cryptogenic stroke. A larger right-to-left shunt or the presence of an atrial septal aneurysm were predictors for a recurrent event. Therefore, percutaneous patent foramen ovale closure after cryptogenic stroke should be recommended over antiplatelet therapy alone in patients younger than 55 years of age with a high-risk patent foramen ovale.

Keywords: Patent foramen ovale; Percutaneous PFO closure; Stroke.

Fig. 1

Algorithm for the treatment of cryptogenic stroke. ASA atrial septal aneurysm, PFO patent foramen ovale, RLS right-to-left shunt, RoPE risk of paradoxical embolism