Patent foramen ovale and stroke: what should be done?

PURPOSE OF REVIEW: The role of a patent foramen ovale (PFO) as a risk factor for ischemic stroke has been established in recent years. However, the best therapeutic option to prevent recurrent events is still controversial, with antithrombotic treatment or transcatheter PFO closure being favored by different clinicians. Also, associated conditions that may guide the therapeutic choices are being investigated.

RECENT FINDINGS: The stroke risk associated with a PFO, mainly considered of importance in younger patients, has also been recognized and better defined in patients over the age of 55 years. The study of potential cofactors that may increase the possibility of paradoxical embolization through the PFO has made some progress and holds promises of allowing more informed and rational treatment choices in the future. More data have become available on the efficacy of transcatheter PFO closure.

SUMMARY: The approach to patients with PFO and ischemic stroke has been better defined in recent years. However, a better understanding of factors that increase the stroke risk in individuals with a PFO and the results from randomized treatment trials comparing medical treatment with PFO closure are needed to further advance the field.