Patent foramen ovale (PFO) and device closure for prevention of recurrent ischemic stroke
• pfo occurs in 25 to 30 percent of the general population.
• Prevalence of PFO is higher in patients with cryptogenic stroke, particularly those under age 55 years in whom PFO is more likely to play a causal role.
• Most individuals with PFO are asymptomatic
• Identification of PFO in a patient with an embolic event does not prove a causal relationship.If a PFO is deemed likely to be causally related to an embolic event,
• therapeutic options for secondary stroke or other embolic event prevention are controversial and include medical therapy with antiplatelet agents or anticoagulation, and surgical or percutaneous closure of the defect.
from uptodate 09/07/2017https://www.uptodate.com/contents/patent-foramen-ovale?source=machineLearning&search=pfo&selectedTitle=1~102§ionRank=1&anchor=H22#H22
03/13/2018 from uptodate
Patent foramen ovale (PFO) device closure for prevention of recurrent ischemic stroke (October 2017)
• Treatment for patients with a cryptogenic stroke who have a patent foramen ovale (PFO) has been controversial.
• In earlier randomized controlled trials, point estimates suggested that percutaneous device closure of a PFO in patients ≤60 years of age was more effective than antiplatelet therapy for reducing recurrent stroke, but the findings did not reach statistical significance.
• However, the results of three recent randomized trials, RESPECT extended follow-up , REDUCE , and CLOSE , provide stronger evidence that device closure of a PFO plus antiplatelet therapy is more effective than antiplatelet therapy alone for preventing recurrent ischemic stroke in such patients, with absolute risk reductions ranging from 2.2 to 6 percent.
• Based upon these results, we now suggest percutaneous PFO closure in addition to antiplatelet therapy for patients who meet all of the following criteria:
=age ≤60 years
= embolic-appearing cryptogenic ischemic stroke (ie, no evident source of stroke despite a comprehensive evaluation)
= and a PFO with a right-to-left interatrial shunt detected by bubble study.
·For patients age ≤60 years with an embolic-appearing cryptogenic ischemic stroke who have a patent foramen ovale (PFO) with a right-to-left shunt detected by bubble study, we suggest percutaneous PFO closure in addition to antiplatelet therapy, rather than antiplatelet therapy alone (Grade 2B).