Prevention of stroke in patients with patent foramen ovale


  • Conflict of interest: Bernhard Meier and Heinrich P. Mattle are the principal investigators of the PC Trial, which is supported by a grant from AGA Medical. Heinrich Mattle has received research grants, speaker's fees, and consulting honoraria from AGA Medical, and Bernhard Meier from AGA Medical, Johnson & Johnson, Occlutech, St. Jude Medical, and NMT Technologies. Krassen Nedeltchev is the principal investigator of the Swiss PFO Consortium (, which is supported by a grant from the Swiss National Research Foundation.

Heinrich Mattle*, Department of Neurology, Inselspital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland. E-mail:


Patent foramen ovale is found in 24% of healthy adults and 38% of patients with cryptogenic stroke. This ratio and case reports indicate that patent foramen ovale and stroke are associated, probably because of paradoxical embolism. In healthy people with patent foramen ovale, embolic events are not more frequent than in controls, and therefore no primary prevention is needed. However, once ischaemic events occur, the risk of recurrence is substantial and prevention becomes an issue. Acetylsalicylic acid and warfarin reduce this risk to the same level as in patients without patent foramen ovale. Patent foramen ovale with a coinciding atrial septal aneurysm, spontaneous or large right-to-left shunt, or multiple ischaemic events potentiates the risk of recurrence. Transcatheter device closure has therefore become an intriguing addition to medical treatment, but its therapeutic value still needs to be confirmed by randomised-controlled trials.