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The first three randomized trials of patent foramen ovale (PFO) closure for patients with cryptogenic stroke were published in 2012 and 2013. Because PFO closure did not prevent recurrent stroke in these studies, a 2016 AAN guideline recommended against this intervention (NEJM JW Neurol Sep 2016 and Neurology 2016; 87:815). However, several later trials demonstrated fewer recurrent strokes with PFO closure: CLOSE, REDUCE, and DEFENSE-PFO (NEJM JW Gen Med Nov 1 2017 and N Engl J Med 2017; 377:1033, 1011, 1022; NEJM JW Cardiol Apr 2018 and J Am Coll Cardiol 2018; 71:2335). The AAN has thus published this practice advisory that reflects an updated meta-analysis.