Cardiovascular Perspective Percutaneous Closure of Patent Foramen Ovale A Near-Perfect Treatment Ruined by Careful Study?

For patients with cryptogenic stroke found to have a patentforamen ovale (PFO), the rationale for mechanical clo-sure can seem deeply compelling. PFO appears to be a common cause of cryptogenic stroke,1 most likely through a “paradoxical ” (venous to arterial) embolism. Since this con-duit can be eliminated with a minimally invasive percutane-ous procedure, why wait around for a second, possibly disabling, event? Indeed, the logic of closure also has strong support from a wealth of observational studies. Our recent review uncovered 57 studies, describing mostly single-arm case series, but also 7 comparative studies of closure versus medical treatment.2 All together, this observational evidence included 8916 pa-tients: 1903 medically treated, 7013 undergoing closure. The summary incidence rate (IR) of recurrent neurological events (stroke or transient ischemic attack) in closure studies wa