Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: An Update

Cardiology. 2019;143(1):62-72. doi: 10.1159/000501028. Epub 2019 Jul 15.


Patent foramen ovale (PFO) is a common benign finding in healthy subjects, but its prevalence is higher in patients with stroke of unclear cause (cryptogenic stroke). PFO is believed to be associated with stroke through paradoxical embolism, and certain clinical and anatomical criteria seem to increase the likelihood of a PFO to be pathological. Recent trials have shown that closure of PFO, especially if associated with an atrial septal aneurysm and/or a large interatrial shunt, may reduce the risk of recurrent stroke as compared to medical treatment. However, it remains challenging to risk stratify patients with suspected PFO-related stroke and to decide if device closure is indicated. We sought to review contemporary evidence and to conclude an evidence-based strategy to prevent recurrence of PFO-related stroke.

Keywords: Cryptogenic stroke; Patent foramen ovale; Percutaneous closure; Transcatheter closure.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Clinical Decision-Making
  • Clinical Trials as Topic
  • Electrocardiography
  • Embolism, Paradoxical / complications
  • Embolism, Paradoxical / etiology
  • Foramen Ovale, Patent / complications*
  • Foramen Ovale, Patent / therapy*
  • Humans
  • Risk Assessment
  • Secondary Prevention
  • Septal Occluder Device
  • Stroke / etiology*
  • Stroke / therapy*
  • Telemetry


  • Anticoagulants