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Brain & Heart Updates on the treatment of PFO

based decisions, yet the precision of treatment selection Availability of data
remains limited in individual cases if only strict criteria are
used. High numbers-needed-to-treat in some “high-risk” Not applicable.
groups suggest unnecessary interventions, while broad Further disclosure
confidence intervals in “low-risk” groups indicate potential
undertreatment due to rigid criteria. Part of work has been presented in the “Heart, Brain and
Vessels” meeting held in Aosta on June 13–14, 2024.
As emphasized in guidance papers, clinical judgment
should always complement formal criteria, considering References
factors beyond current classifications. For instance, on
the one hand, PFO closure might be appropriate in a 1. Pristipino C, Sievert H, D’Ascenzo F, et al. European
position paper on the management of patients with patent
young PFO-associated cryptogenic stroke patient despite foramen ovale. General approach and left circulation
an “unlikely” PASCAL classification if the stroke clearly thromboembolism. Eur Heart J. 2019;40(38):3182-3195.
coincided with a pulmonary embolism. On the other
hand, in elderly people, the complexity of comorbidities doi: 10.1093/eurheartj/ehy649
in real life may render possible positive results of ongoing 2. Wein T, Lindsay MP, Côté R, et al. Canadian stroke best
randomized studies problematic to generalize. practice recommendations: Secondary prevention of stroke,
sixth edition practice guidelines, update 2017. Int J Stroke.
Scientifically, the simultaneous high prevalence of PFO 2018;13(4):420-443.
and a rare causal impact highlight the possible shortcomings
of classic statistics and the need for complexity-based doi: 10.1177/1747493017743062
approaches. Deterministic models may no longer suffice; 3. Messé SR, Gronseth GS, Kent DM, et al. Practice advisory
instead, multiparametric phenotyping and big data update summary: Patent foramen ovale and secondary
tools offer promise for refining patient selection. These stroke prevention: Report of the guideline subcommittee
challenges exemplify broader issues in medicine, where of the American academy of neurology. Neurology.
PFO management could lead the way in developing 2020;94(20):876-885.
precision treatments. The convergence of technology and doi: 10.1212/WNL.0000000000009443
data science signals a transformative era in individualized 4. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021
care, while attempting to address a single cause of disease Guideline for the prevention of stroke in patients with
may be unrealistic in complex scenarios such as in the stroke and transient ischemic attack: A guideline from the
increasing elderly population where simultaneous multiple American heart association/American stroke association.
forms of prevention may be required at the individual level. Stroke. 2021;52(7):e364-e467.
Acknowledgments doi: 10.1161/STR.0000000000000375

None. 5. Kavinsky CJ, Szerlip M, Goldsweig AM, et al. SCAI
Guidelines for the management of patent foramen ovale.
Funding J Soc Cardiovasc Angiogr Interv. 2022;1(4):100039.
doi: 10.1016/j.jscai.2022.100039
None.
6. Caso V, Turc G, Abdul‑Rahim AH, et al. European stroke
Conflict of interest organisation (ESO) guidelines on the diagnosis and
management of patent foramen ovale (PFO) after stroke.
The authors declare they have no competing interests.
Eur Stroke J. 2024;9(4):800-834.
Author contributions doi: 10.1177/23969873241247978
Conceptualization: All authors 7. Kent DM, Saver JL, Kasner SE, et al. Heterogeneity of
Writing–original draft: All authors treatment effects in an analysis of pooled individual patient
Writing–review & editing: All authors data from randomized trials of device closure of patent
foramen ovale after stroke. JAMA. 2021;326(22):2277-2286.
Ethic approval and consent to participate doi: 10.1001/jama.2021.20956
Not applicable. 8. Pristipino C, Carroll J, Mas JL, Wunderlich NC,
Sondergaard L. Treatment of patent foramen ovale.
Consent for publication Eurointervention. 2025;21(10):505-524.
Not applicable. doi: 10.4244/EIJ‑D‑23‑00915

Volume 3 Issue 3 (2025) 6 doi: 10.36922/bh.8133