Comeback for PFO Closure After Cryptogenic Stroke?

Paradoxical embolism through a patent foramen ovale (PFO) is considered to be responsible for some otherwise unexplained (“cryptogenic”) strokes. Nevertheless, in three randomized trials published several years ago, PFO closure in patients with cryptogenic stroke did not prevent recurrent stroke. However, several 2017 studies — involving younger adults (age, ≤60) with recent cryptogenic stroke and PFO — suggest that carefully selected patients might, in fact, benefit from PFO closure.

A French study (CLOSE) involved 663 patients whose PFOs were associated with large right-to-left interatrial shunts or atrial septal aneurysms. Most patients were randomized to transcatheter PFO closure plus antiplatelet therapy, antiplatelet therapy alone, or …