Percutaneous PFO Closure Tied to Lower Risk for Recurrent Stroke

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Patent foramen ovale (PFO) closure is associated with reduced risk for recurrent stroke among patients with cryptogenic stroke, according to two meta-analyses in the Annals of Internal Medicine.

In each meta-analysis, researchers examined four randomized trials comparing percutaneous PFO closure with medical therapy alone in roughly 2500 patients with PFO and cryptogenic stroke.

In the first analysis, the rate of stroke or transient ischemic attack was lower with PFO closure than with medical therapy (3.6% vs. 6.3%). However, the rate of new-onset atrial fibrillation or atrial flutter was higher with PFO closure (4.1% vs. 1.0%).

The second analysis showed a similar reduction in stroke recurrence favoring PFO closure. Again, the data pointed to an increased risk for atrial fibrillation, but heterogeneity among the trials led the researchers to consider this finding inconclusive.

The authors of the first analysis conclude: "Our results demonstrate the superiority of percutaneous PFO closure compared with medical treatment alone in preventing recurrent stroke or TIA in PFO carriers with cryptogenic stroke."