PFO Closure for Cryptogenic Stroke

Abstract

A patent foramen ovale (PFO) is a common finding in the general population and has been theorized to be a mechanism for ischemic stroke primarily due to a deep venous thrombus embolizing through the shunt into the arterial circulation. There has been much debate regarding the association between PFO and stroke, especially in the case of a cryptogenic stroke (i.e., stroke of unknown etiology) in a younger patient without other risk factors. Traditionally, when a PFO is detected, antithrombotic therapy to mitigate risk of a future ischemic event has been the mainstay of treatment. More recently, both surgical and transcatheter closure of a PFO have been widely utilized. However, there are only few randomized controlled trials assessing the efficacy of PFO closure for stroke prevention.

Patent foramen ovale closure versus medical therapy for stroke prevention: A systematic review and meta-analysis of randomized controlled trials

“…The association between the presence of a patent foramen ovale (PFO) and cryptogenic stroke has been established by previous case-control studies 1 . However, whether PFO closure is effective in reducing stroke events when compared to medical therapy is controversial.…”

A whole-exome sequencing study of patent foramen ovale: investigating genetic variants and their association with cardiovascular disorders

“…This physiological pathway is crucial during fetal development, but if it remains open after 3 years age, it is referred to as PFO. PFO has been associated with various diseases, including migraine, cryptogenic stroke (CS), and decompression sickness ( Gillow and Lee, 2015 ; Lafère et al, 2017 ; Mojadidi et al, 2021b ). CS, as a severe adverse outcome of patent foramen ovale (PFO), is influenced significantly by genetic factors ( Bo et al, 2018 ; He et al, 2018 ).…”