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These four trials, published in 2012, are major contributions to evidence-based practice of cardiovascular medicine.
Paradoxical embolism through a patent foramen ovale (PFO) almost certainly causes a small proportion of cryptogenic strokes. However, PFO is common in the general population, and proving that paradoxical embolism was responsible for a given stroke usually is impossible. The CLOSURE I trial involved 900 young patients (age, <60) with PFO, right-to-left atrial shunting during a Valsalva maneuver, and recent stroke or transient ischemic attack with no other obvious cause. Patients were randomized to undergo either catheter-based PFO closure (with the STARFlex device) or medical therapy alone. During 2 years of follow-up, the devi…