Closure of a PFO may prevent paradoxical embolism by preventing a venous thrombus from passing through the PFO and thereby reducing the risk of recurrent stroke. While some results are conflicting, evidence from the most recent randomized controlled trials now suggests that PFO closure is effective in reducing the risk of recurrent stroke for select patients who have had a PFO-associated stroke.
For patients who are ≤60 years old, have a PFO, and have experienced an ischemic stroke, PFO closure may be warranted. A critical piece in determining if a patient can benefit from PFO closure is ensuring that a comprehensive stroke workup is completed, concluding that no other evident source of stroke can be found, and the evaluation suggests that the embolism passed through the PFO.
PFO closure is a catheter-based procedure that involves making a very small skin incision, guided by fluoroscopy and intracardiac echocardiography, and inserting a catheter to guide the PFO occluder through the blood vessels to close the PFO.
Shared decision making
Neurologists and cardiologists should discuss consideration of the PFO closure procedure, including benefits, risks, and alternative treatment options with the patient. The patient should understand the immediate and long-term potential benefits and risks of treatment options to make a well-informed decision that considers their values and preferences.