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(Stroke. 2004;35:804.)
© 2004 American Heart Association, Inc.

Controversies in Stroke

Patent Foramen Ovale and Recurrent Stroke: Closure Is the Best Option: No

From the Department of Neurology and Neurological Sciences (D.C.T.), Stanford Medical Center, Palo Alto, Calif; and Harborview Medical Center (K.J.B.), Seattle, Wash.

Correspondence to David C. Tong, MD, 701 Welch Rd, Suite 325B, Palo Alto, CA 94304. E-mail dct@stanford.edu

Key Words: foramen ovale, patent • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Patients with patent foramen ovale (PFO) experiencing ischemic cerebrovascular symptoms should not routinely undergo closure. A clear relationship between PFO and stroke has not yet been proven. Even if PFOs are shown to predispose to stroke, medical therapies for stroke prevention in patients with PFOs have not been adequately tested, making comparisons with invasive treatment difficult, and probably premature.

Where’s the Evidence?

Several small, uncontrolled studies have suggested a relationship between PFO and stroke. Recent data, however, indicate that these studies may overestimate the association. In one study, PFOs were found in 20.8% of 519 randomly selected asymptomatic community-based controls compared with 16.5% of 158 patients referred for evaluation of cryptogenic stroke, demonstrating no increase in the prevalence of PFO among patients with stroke compared with a random nonhospitalized reference population.¹

Only 2 prospective multicenter studies of substantial size have evaluated the stroke recurrence risk in patients with PFO. These studies provide the best data for guiding the management of patients with PFO and ischemic cerebrovascular events.

The French PFO-ASA Study Group evaluated 216 young patients (aged 18 to 55, mean age 40) with PFO and cryptogenic stroke and compared them with 304 cryptogenic stroke patients without PFO.² All patients were extensively screened for alternative stroke etiologies, including coagulation testing and transesophageal echocardiography. Treatment consisted of aspirin (300 mg) in all cases. In this study, patients with PFO alone had a nonsignificantly lower stroke risk than those without a PFO at 4-year follow-up (2.3% PFO[+] versus 4.2% PFO[-]). Only patients with both PFO . . . [Full Text of this Article]

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