Broadening Our SCOPE of Understanding Patent Foramen Ovale High-risk Features and Stroke

Paradoxical embolization of a blood clot of presumed venous origin through a patent foramen ovale (PFO) is increasingly recognized as a legitimate cause of otherwise cryptogenic ischemic stroke (CIS). The term PFO-associated stroke has been proposed, as has where and how to classify this entity in the nomenclature of various ischemic stroke subtyping systems. PFOs are common, with prevalence as high as 25% in the general population. The prevalence of PFO is further increased in patients with CIS (overall 2.9 times higher), and especially so in the subset of younger patients (<55 years, 5.1 times higher). One estimate of the magnitude of PFO-associated stroke in younger individuals in the United States is approximately 13  000 per year and globally approximately 250 000, representing about 10% of all ischemic strokes in those aged 18 to 60 years. Over the last decade, multiple randomized clinical trials (RCTs) of PFO closure, focused largely on carefully selected young patients with CIS, have demonstrated signifi cant and large relative risk reduction of recurrent ischemic stroke, smaller absolute risk reductions, and a small increased risk of postprocedural persistent atrial fibrillation. As a result, multiple medical societal guidelines now endorse PFO closure as an effective intervention for secondary str oke prevention in carefully selected patients.
Source: JAMA Neurology - Category: Neurology Source Type: research