Patent Foramen Ovale Closure —Harnessing Clinical Trial Evidence to Inform Individualized Treatment Decisions

According to some estimates, approximately one-quarter of the general US population has a patent foramen ovale (PFO). With such a high prevalence, clinicians frequently attempt to determine whether a PFO has had a causal role among patients who experience an unexplained stroke, and whether closing the PFO might reduce the risk of recurrent stroke. Several randomized clinical trials have compared the outcomes of PFO closure vs treatment with antiplatelet or anticoagulation agents. In 2016, the American Academy of Neurology conducted a systematic review of 3 trials and concluded that clinicians “should not routinely offer percutaneous PFO closure to patients with cryptogenic ischemic stroke outside of a research setting.” However, these guidelines were revised 4 years later following the publication of 4 additional studies that demonstrated significant reductions in recurrent stroke af ter PFO closure compared with medical treatment. Currently, PFO closure may be recommended for patients younger than 60 years with “embolic-appearing infarct and no other mechanism of stroke identified…following a discussion of potential benefits…and risks.”
Source: JAMA - Category: General Medicine Source Type: research