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Patent Foramen Ovale (PFO): A Potential Risk for Stroke

Written by Zach Singsank, DO

Strokes are very common and potentially life-threatening. Most strokes are caused by impaired blood flow to the brain due to a blood clot. After initial treatment in the hospital following a stroke, people are typically placed on medical therapy with anticoagulation (blood-thinners) or antiplatelet therapy with one or two medications such as aspirin. In most cases these medications are continued for the remainder of the person’s life.

After having a stroke it’s important to rule out potential causes in an effort to reduce future preventable strokes. 

This includes looking for:

  • Atrial fibrillation (afib)
  • Atherosclerosis of the brain and neck arteries
  • Blood coagulation disorders
  • A defect in the heart called patent foramen ovale (PFO)

PFO and Stroke

Patent foramen ovale (PFO) is a small defect that everyone is born with. However, for roughly 20-25 percent of people it doesn’t close. Usually this doesn’t cause any problems, but it is a potential cause of stroke. Normally, if a small blood clot went to the heart it would get “stuck” in the lungs and the body would clear it out. In the setting of a PFO it could cross over into the left side of the heart wherein it would then possibly flow to the brain leading to a stroke. 

Low Risk, Highly Effective Treatment to Close PFO

Roughly one-third of strokes are cryptogenic, which means they have no clear cause. In this setting having a PFO is potentially the cause and closing the PFO should be discussed. Closing a PFO is an outpatient procedure done with a small mesh device implanted via catheters inserted in the leg veins through a very small incision in the skin. Typically the patient will go home the same day as the procedure and be on two antiplatelet medications for one month and then aspirin for life.

Studies Prove PFO Effective in Preventing Future Stroke

Multiple studies have shown the procedure is safe and low risk of major complications.  Initially, studies did not demonstrate closing the PFO to be more effective in preventing future strokes than using medical therapy. However, this was due to poor patient selection. Subsequent studies took patients (18-60 years old) who had cryptogenic strokes and clearly demonstrated that PFO closure was more effective at preventing future strokes compared to medical therapy. The results are not known for those >60 years old and long-term follow up (>six years) is not known.  Despite these limitations, the evidence is clear that this procedure is low-risk and effective.

Bryan Heart Cardiologists Provide Expertise in PHO and Cryptogenic Stroke

It is not uncommon for patients who suffered a stroke to live in fear of another stroke. At the same time they may not want to be on medications like blood thinners long-term. PFO closure may be the right choice in that setting. 

If you have questions regarding PFO, treatment for PFO or have a patient who has suffered a cryptogenic stroke with a PFO, call Bryan Heart at 402-483-3333.

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