Patent foramen ovale in patients with cryptogenic stroke: to close or not to close?

Evidence exists supporting percutaneous patent foramen ovale
(PFO) closure and medical therapy versus medical therapy alone in
selected patients with cryptogenic stroke (CS). However, the procedure
may be associated with cardiac complications. Transoesophageal
echocardiography (TOE), despite its limitations, is considered the ‘gold
standard’ for PFO diagnosis but an unequivocal diagnostic algorithm for
the detection of PFO and its treatment is still lacking.  The Pascal
classification system recommends PFO closure plus antiplatelet therapy
in selected patients aged under 60 years (essentially those with a large
right-to-left shunt or an atrial septal aneurysm), without other
evident cause of stroke.