Title:Percutaneous Patent Foramen Ovale Closure: Stroke and Beyond
Volume: 20
Issue: 3
Author(s): Sandeep Randhawa*, Jawahar L. Mehta and Gaurav Dhar
Affiliation:
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Keywords:
Patent foramen ovale, cryptogenic stroke, ischemic stroke, patent foramen ovale closure, paradoxical embolism, atrial septal defect, right-to-left shunt.
Abstract: Over 750,000 individuals suffer from stroke annually in the United States, with 87%
of these strokes being ischemic in nature. Roughly 40% of ischemic strokes occur in individuals
60 years of age or under. A quarter of all ischemic strokes have no identifiable cause despite
extensive workup and are deemed cryptogenic in nature. Patent Foramen Ovales (PFO)
has been postulated in stroke causation by either paradoxical embolization or platelet activation
in the tunnel of the defect. The incidence of PFO is reported to be 15-25% in the general population
but rises to 40% in patients with cryptogenic stroke. While the initial trials evaluating
PFO closures were non-revealing, subsequent long-term follow-ups, as well as recent trials
evaluating PFO closures in cryptogenic stroke patients 60 years of age or under, demonstrated
the superiority of percutaneous closure compared to medical therapy alone, leading to FDA
approval of PFO closure devices. In this review, we review the diagnosis of PFO, postulated
stroke mechanisms, literature supporting PFO closure, patient selection for percutaneous closure,
procedural considerations, and associated procedural complications.
