Comparative Effectiveness of Patent Foramen Ovale Closure and Medical Therapy in Cryptogenic Stroke: A Focused Review of Current Evidence

Background: Patent foramen ovale (PFO) is an anatomical variant in which the normal fetal interatrial passage persists after birth. It is estimated to be present in approximately 25% of adults. Furthermore, it appears to be involved in 50% of cryptogenic strokes. A cryptogenic stroke means the etiology remains unknown despite a thorough assessment (including arterial imaging, echocardiography, rhythm monitoring, and relevant laboratory testing, such as lipid profile and hemoglobin A1c). Secondary prevention options after a PFO-associated stroke consist of antiplatelet therapy, anticoagulant therapy, or percutaneous closure of the PFO, and it is still debatable which option is better. Objective: To critically review the available evidence regarding PFO closure vs. medical therapy as the optimal therapeutic option for secondary prevention after PFO-associated cryptogenic stroke, and to discuss relevant factors for patient selection. Methods: We conducted a focused review and searched the PubMed database for relevant literature on the subject. We included records about patients with PFO and a history of stroke. We chose to include only the free full-text sources. On the other hand, studies regarding children, studies comparing different devices or techniques, and observational studies on long-term complications and recurrence predictors were excluded. Results: Eight records were included, comprising 3750 participants, all diagnosed with PFO and stroke, to compare different therapeutic strategies for preventing stroke recurrence (PFO closure versus medical therapy). Conclusions: The results indicated that closure of PFO may provide greater protection against recurrent stroke than medical therapy alone in adequately selected patients with PFO-associated cryptogenic stroke. Additionally, given the lack of recent studies, further research is warranted to improve patient selection and evaluation of medium- and long-term prognosis.