Management of patent foramen ovale in patients with cryptogenic stroke: Is device closure superior to medical treatment? A brief review

BACKGROUND: Recent randomized controlled trial (RCTs) comparing percutaneous closure with antithrombotic treatment in patients with patent foramen ovale (PFO) and cryptogenic stroke revealed inconsistent results. Indeed, there is still no consensus on the management of these patients, namely closure or medical therapy treatment. METHODS: To take stock of the PFO management after cryptogenic stroke, we conducted a literature review that included 16 articles dealing with different therapeutic strategies and long-term outcomes of these results. RESULTS: The reviewed studies showed great methodological diversity rendering an exhaustive and balanced comparison between studies difficult. Low recurrence rates under prevention regimens, crossovers, procedure- and device-related complications, as well as inappropriate patient selection might explain the inconsistency of trials. However, despite the methodological heterogeneity certain patterns could be detected. It appears that device closure as secondary prevention measure is an effective and safe procedure reducing the recurrence of neurological events in cryptogenic stroke patients <60 years with large PFOs. Standardization of procedures and larger trials are needed to arrive to definitive conclusions. CONCLUSION: In cryptogenic stroke patients <60 years with large PFOs, PFO closure seems to be safe and more effective compared to medical treatment alone. For all other patients group, for example, patients >60 years further trials are needed to clarify the role of PFO closure.