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Review
Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention
  1. Kristy Yuan,
  2. Scott Eric Kasner
  1. Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Kristy Yuan; Qingyang.yuan{at}uphs.upenn.edu

Abstract

The patent foramen ovale (PFO), given its high prevalence in the general population and especially in patients with cryptogenic stroke, has long generated investigation and debate on its propensity for stroke by paradoxical embolism and its management for stroke prevention. The pendulum has swung for percutaneous PFO closure for secondary stroke prevention in cryptogenic stroke. Based on a review of current evidence, the benefit from PFO closure relies on careful patient selection: those under the age of 60 years with few to no vascular risk factors and embolic-appearing stroke deemed cryptogenic after thorough evaluation. As these data look towards influencing guideline statements and device approvals in the future, patient selection remains the crucial ingredient for clinical decision making and future trials.

  • cryptogenic stroke
  • patent foramen ovale
  • paradoxical embolism
  • pfo closure
  • stroke prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/svn-2018-000173

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    Footnotes

    • Contributors KY and SEK cowrote this paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests KY reports no conflict of interest. SEK reports a research grant from WL Gore & Associates.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement No additional data are available.

    • Presented at The recently published DEFENSE PFO trial was concordant with the results presented here (Lee PH, Song JK, Kim JS, Heo R, et al. Cryptogenic stroke and high risk patent foramen ovale: The DEFENSE PFO trial. J Am Coll Cardiol. 2018;71(20):2335–42.)

    • Guest chief editor J David Spence

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