More Controversy About the Role of a PFO in Stroke? by Bryan Kluck

Recently, three publications have fundamentally changed the paradigm in approaching patients with cryptogenic stroke. The Extended RESPECT, REDUCE and CLOSE studies demonstrate quite convincingly that PFO Closure reduced recurrent neurologic events in patients who were highly likely to have a PFO attributable stroke. PFO Closure, long an off-label procedure, now has one FDA approved device with more likely to follow.

In a recent online publication in the Journal of the American Medical Association, Ng et al reported a higher risk of perioperative stroke with a previously diagnosed PFO. The retrospective study demonstrated that the 30-day stroke rate of patients with known PFO reached 3.2% while those without a diagnosed PFO was 0.5%. In addition those with known PFO were at increased risk of large vessel stroke and had more severe neurologic deficits. This data is sure to spark future investigation and considerable controversy.

At the upcoming C3 conference (, the changing treatment of PFO is slated to be a major topic. Discussion and debate on the studies surrounding stroke reduction in cryptogenic stroke as well as workshops on devices and technique will take place. With the emergence of this data, the debate about the evolving role of PFO in many clinical conditions will define C3 as the “Go To” PFO meeting

1. JAMA. 2018;319(5):452-462. doi:10.1001/jama.2017.21899
2. N Engl J Med 2017; 377:1011-1021
3. N Engl J Med 2017; 377:1022-1032
4. N Engl J Med 2017; 377:1033-1042