Background

Patent foramen ovale (PFO) is a common congenital interatrial communication present in approximately 25% of the adult population. Increasing evidence suggests an association between PFO and cryptogenic stroke, particularly in younger patients without traditional vascular risk factors. Percutaneous PFO closure has emerged as an important therapeutic strategy for secondary stroke prevention.

Objective

To evaluate contemporary evidence regarding PFO closure for stroke prevention, assess procedural outcomes, and discuss future directions in patient selection and management.

Methods

A narrative review was conducted using published randomized controlled trials, observational studies, meta-analyses, and guideline recommendations concerning PFO closure and recurrent stroke prevention.

Results

Major randomized trials including RESPECT, CLOSE, REDUCE, and DEFENSE-PFO demonstrated significant reductions in recurrent ischemic stroke among selected patients undergoing PFO closure compared with medical therapy alone. Relative risk reductions ranged from 45% to 77%. Device implantation success exceeded 95%, while procedural complications remained low. New-onset atrial fibrillation represented the most common adverse event.

Conclusion

PFO closure is an effective strategy for secondary stroke prevention in carefully selected patients with cryptogenic stroke and high-risk PFO anatomy. Continued refinement of patient selection criteria and long-term outcome evaluation remain essential.