Closure of patent foramen ovale in cryptogenic stroke: a never ending story

Purpose of reviewThis review discusses current evidence on patent foramen ovale (PFO) closure compared with medical therapy alone in the prevention of stroke recurrence in patients with a PFO-associated cryptogenic stroke.Recent findingsThe Risk of Paradoxical Embolism group built a 10-point Score, based on clinical parameters, that estimates the probability of finding a PFO in a patient with cryptogenic stroke and the probability that a PFO discovered in the setting of cryptogenic stroke is related to stroke vs. incidental.Three recent randomized clinical trials failed to demonstrate the superiority of PFO closure over medical treatment alone in preventing stroke recurrence in patients aged 18-60 years who have had a cryptogenic stroke or transient ischemic attack.SummaryStronger evidence in favor of PFO closure is needed before recommending this procedure outside of a clinical trial. Results of ongoing trials are much awaited.