PFO: Button me up, but wait … Comprehensive evaluation of the patient.
Patent foramen ovale (PFO) is a slit or tunnel-like communication in the atrial septum occurring in approximately 25% of the population. A wide number of pathological conditions have been linked to its presence, most notably, cryptogenic stroke (CS) and migraine. However, in the setting of a neurological event, it is not often clear whether the PFO is pathogenically related to the index event or an incidental finding. Therefore, a detailed analysis of several clues is needed for understanding PFO's clinical significance, with a frequent case-by-case decision about destination therapy. Indeed, the controversy about PFO's pathogenicity prompted a paradigm shift of research interest from medical therapy with antiplatelets or anticoagulants to percutaneous transcatheter closure, in secondary prevention. Observational data and meta-analysis of observational studies had previously suggested that PFO closure with a device was a safe procedure with a low recurrence rate of stroke. To date, however, recent randomized controlled trials have not shown the superiority of PFO closure over medical therapy. Thus, the optimal strategy for secondary prevention of paradoxical embolism in patients with a PFO remains unclear. Moreover, the latest guidelines for the prevention on stroke restricted indications for PFO closure to patients with deep vein thrombosis and high-risk of its recurrence. Given these recent data, in the present review, we critically discuss current treatment options, pointing out the role of a comprehensive patient evaluation in overcoming PFO closure restrictions and planning the best management for each patient.
['Pizzino|Fausto|F|', 'Khandheria|Bijoy|B|', 'Carerj|Scipione|S|', 'Oreto|Giuseppe|G|', 'Cusmà-Piccione|Maurizio|M|', 'Todaro|Maria Chiara|MC|', 'Oreto|Lilia|L|', 'Vizzari|Giampiero|G|', 'Di Bella|Gianluca|G|', 'Zito|Concetta|C|']
D000925:Anticoagulants D054087:Atrial Septum D006348:Cardiac Surgical Procedures D019320:Embolism, Paradoxical D054092:Foramen Ovale, Patent D006801:Humans D008881:Migraine Disorders D018579:Patient Selection D012008:Recurrence D055502:Secondary Prevention D020521:Stroke
Patent foramen ovale Cryptogenic stroke Transcatheter closure Device