The Paradigm of Patent Foramen Ovale and Cryptogenic Stroke

摘要

The paradigm of patent foramen ovale (PFO) and cryptogenic stroke has continued for over a century. Although PFO closure in the context of cryptogenic stroke has become clinical routine in many places, there is no evidence to support this practice. Whilst a plethoric of data is available on PFO closure, mainly in the context of cryptogenic stroke, the data comes from non-randomised studies or anecdotal cases. Few studies have focused on medical treatment of cryptogenic stroke and PFO. The latest guidelines continue to reflect the lack of randomised data in this area. The report of the CLOSURE I Study marks the beginning of a series of randomised studies which would, hopefully, solve this paradigm and should not be taken as the conclusion or met with pessimism. Until then, physicians and interventionalists will continue to face the dilemma when dealing with these patients. This review discusses such dilemma and available data with some case vignettes. Consensus statements, consistency in local practice, clinical judgement and commitment to clinical trials may help to guide the management of such patients.