Patent foramen ovale and cryptogenic stroke: is there still a role for percutaneous closure?

Christian Spies* and Ziyad M Hijazi

Ischemic strokes and patent foramen ovale (PFO) are two common conditions. PFO is more commonly found in patients with cryptogenic strokes, the largest subset of patients with ischemic stroke. Over the past 20 years, a large body of evidence (retrospective data) has been generated evaluating medical management and percutaneous PFO closure, which suggests PFO closure may be superior to medical management. To date, three randomized controlled trials have been completed, one of which has been published (CLOSURE 1) and two have been presented recently (RESPECT and PC-Trial). Overall, these studies did not demonstrate superiority of device closure over medical therapy. This article reviews the current data of percutaneous PFO closure and tries to identify a subgroup of patients in whom PFO closure may still be of benefit.