Device closure for patent foramen ovale in patients with cryptogenic stroke: a paradigm in evidence

Recent randomised trials will alter management of patent foramen ovale in patients with cryptogenic stroke

Cryptogenic stroke is a devastating event in young patients. Patent foramen ovale (PFO) may be related to this type of stroke in certain cases and can be closed with a percutaneous device. However, due to perceived lack of benefit in early trials, this procedure has not been routinely performed in the past. Guidelines from the American Heart Association and the American Stroke Association published in 2014 state that “for patients with a cryptogenic [ischaemic] stroke or [transient ischaemic attack] and a PFO without evidence for [deep vein thrombosis], available data do not support a benefit for PFO closure”.1 But the results of recent trials and newly revised guidelines recommendations will see a change in landscape.