Patent foramen ovale and stroke: from diagnosis to treatment—a clinical practice review
- 1Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
Abstract
Patent foramen ovale (PFO) is present in 25% of the general population. However, its prevalence increases to 50–60% in young cryptogenic stroke patients. Early randomized trials of PFO closure shows no significant improvement in future stroke risk, largely owing to suboptimal patient selection and limited power. With careful case selection and longer follow-up time, PFO closure has been shown to improve future stroke events in multiple landmark trials. Therefore, current practice of PFO closure in young stroke patients emphasizes on diagnostic workup and risk stratification, to better classify which PFOs are likely contributing to the stroke etiology. The PFO-associated stroke causal likelihood (PASCAL) risk stratification system combines patient underlying demographics with PFO anatomy to determine the PFO-stroke causal relationship. It has been shown to be effective in distinguishing patients who are likely to benefit from PFO closure. In borderline cases, a heart-brain team approach is advocated to further identify patients whose stroke is likely caused by PFO. Current success rate of PFO closure is nearly 100% with high safety profile. Careful device sizing and selection minimizes residual shunt. Atrial fibrillation after PFO closure is mostly transient and occurs in the first 3 months after the procedure. Anticoagulation is generally not necessary. Future studies should focus on bioresorbable or suture-based device would further improve outcome, and whether PFO closure could benefit elderly cryptogenic stroke patients after comprehensive evaluation.
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BibTeX
@article{ho2026patent,
title = {{Patent foramen ovale and stroke: from diagnosis to treatment—a clinical practice review}},
author = {Cheuk Bong Ho and Calvin Leung and Hon Yeung Ko and Po Kwan Ng and Kevin Wai Ching Lun and Michael Chi Shing Chiang and Shing Fung Chui and Michael Kang Yin Lee and Chi Yuen Wong},
journal = {Cardiovascular Diagnosis and Therapy},
year = {2026},
month = oct,
doi = {10.21037/cdt-2026-0368},
url = {https://doi.org/10.21037/cdt-2026-0368},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Patent foramen ovale and stroke: from diagnosis to treatment—a clinical practice review
AU - Cheuk Bong Ho
AU - Calvin Leung
AU - Hon Yeung Ko
AU - Po Kwan Ng
AU - Kevin Wai Ching Lun
AU - Michael Chi Shing Chiang
AU - Shing Fung Chui
AU - Michael Kang Yin Lee
AU - Chi Yuen Wong
PY - 2026
DA - 2026/10/19
JO - Cardiovascular Diagnosis and Therapy
DO - 10.21037/cdt-2026-0368
UR - https://doi.org/10.21037/cdt-2026-0368
AB - Patent foramen ovale (PFO) is present in 25% of the general population. However, its prevalence increases to 50–60% in young cryptogenic stroke patients. Early randomized trials of PFO closure shows no significant improvement in future stroke risk, largely owing to suboptimal patient selection and limited power. With careful case selection and longer follow-up time, PFO closure has been shown to improve future stroke events in multiple landmark trials. Therefore, current practice of PFO closure in young stroke patients emphasizes on diagnostic workup and risk stratification, to better classify which PFOs are likely contributing to the stroke etiology. The PFO-associated stroke causal likelihood (PASCAL) risk stratification system combines patient underlying demographics with PFO anatomy to determine the PFO-stroke causal relationship. It has been shown to be effective in distinguishing patients who are likely to benefit from PFO closure. In borderline cases, a heart-brain team approach is advocated to further identify patients whose stroke is likely caused by PFO. Current success rate of PFO closure is nearly 100% with high safety profile. Careful device sizing and selection minimizes residual shunt. Atrial fibrillation after PFO closure is mostly transient and occurs in the first 3 months after the procedure. Anticoagulation is generally not necessary. Future studies should focus on bioresorbable or suture-based device would further improve outcome, and whether PFO closure could benefit elderly cryptogenic stroke patients after comprehensive evaluation.
SN - 2223-3652
SN - 2223-3660
ER -