PFO

Posted On March 16, 2020

Patent foramen ovale

a simplified view of pfo
  • 25-30 percent of population has PFO based on autopsy and community based TEE study.
  • Size of PFO increases with age
  • Most patients are asymptomatic

In cryptogenic stroke

  • Cryptogenic stroke accounts for 20-40% of ischemic stroke
  • Most of these are embolic
  • Paradoxical embolism from PFO is one of the mechanism that cause the stroke.
  • Migraine may be associated with PFO, and closure of the PFO may help the migraine.

Treatment

  • percutaneous PFO closure is more effective than antiplatelet therapy alone for selected patients to prevent stroke, if
    • under the age of 60
    • embolic appearing cryptogenic ischemic stroke
    • No other evident cause of stroke despite a comprehensive evaluation
  • Cryptogenic stroke after comprehensive evaluation means
    • No large vessel stenosis over 50% or occlusion in territory of stroke
    • No occult atrial fibrillation or other cardioembolic source
    • Not a lacunar infarct on imaging study or clinical exam
    • Blood test for hypercoagulation state is negative

AAN updated advisory for PFO closure

References reviewed on 05/03/2020

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