The role of patent foramen ovale (PFO) in stroke was debated for decades. Randomized
clinical trials (RCTs) have shown fewer recurrent events after PFO closure in patients
with cryptogenic stroke (CS). However, in clinical practice, treating stroke patients
with coexisting PFO raises some questions. This brief review summarizes current
knowledge and challenges in handling stroke patients with PFO and identifies issues
for future research. The rationale for PFO closure was initially based on the concept
of paradoxical embolism from deep vein thrombosis (DVT). However, RCTs did not
consider such details, limiting their impact from a pathophysiological perspective.
Only a few studies explored the coexistence of PFO and DVT in CS with varying
results. Consequently, the PFO itself might play a role as a prothrombotic structure.
Transesophageal echocardiography thus appears most appropriate for PFO detection,
while a large shunt size or an associated atrial septum aneurysm qualify for a high-risk
PFO. For drug-based treatment alone, studies did not find a definite superiority of oral
anticoagulation over antiplatelet therapy. Remarkably, drug-based treatment in addition
to PFO closure was not standardized in RCTs. The available literature rarely considers
patients with transient ischemic attack (TIA), over 60 years of age, and competing
etiologies like atrial fibrillation. In summary, RCTs suggest efficacy for closure of high-risk
PFO only in a small subgroup of stroke patients. However, research is also needed to
reevaluate the pathophysiological concept of PFO-related stroke and establish strategies
for older and TIA patients and those with competing risk factors or low-risk PFO.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:85823 |
| Date | 06 June 2023 |
| Creators | Huber, Charlotte, Wachter, Rolf, Pelz, Johann, Michalski, Dominik |
| Publisher | Frontiers Media S.A. |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 855656 |
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