Korean Circ J.  2022 Nov;52(11):801-807. 10.4070/kcj.2022.0258.

Percutaneous Patent Foramen Ovale Closure After Stroke

  • 1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
  • 2Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea


Percutaneous patent foramen ovale (PFO) closure in patients with a prior PFO-associated stroke showed a risk reduction of the stroke recurrence compared to the medical therapy alone in recent several studies. Nevertheless, optimal patient selection for PFO closure has not been clarified. In this paper, we discuss the characteristics of PFO-associated strokes and discuss the recently published evidence and patient selection for PFO closure in patients with ischemic stroke. The lesions characteristics of PFO-associated stroke are associated with multiple scattered lesion, small sized cerebral cortical lesion, or posterior circulation. Overcoming the failure of early studies in CLOSURE I, PC, and RESPECT trials, PFO closure showed a significant reduction in recurrent stroke in recently published REDUCE, CLOSE, DEFENSEPRO trials, and long-term follow-up data of RESPECT study. However, considering that PFO closure cannot completely prevent stroke recurrence and that complications including atrial fibrillation, we should be selectively performed in patients with high-risk PFO.


Patent foramen ovale; Stroke; Paradoxical embolism


  • Figure 1 RoPE and PASCAL scoring system.9) ASA = atrial septal aneurysm; LS = large shunt; PASCAL = Patent Foramen Ovale-Associated Stroke Causal Likelihood; PFO = patent foramen ovale; RoPE = risk of paradoxical embolism; TIA = transient ischemic attack.


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