The American Academy of Neurology (AAN) published a practice advisory in 2016 regarding secondary stroke prevention in patients with patent foramen ovale (PFO).1 Additional randomized trials have since been published, and the Food and Drug Administration approved the AMPLATZER PFO Occluder and GORE CARDIOFORM Septal Occluder for use in the United States, necessitating an update. The clinical questions remain unchanged:
In patients with a PFO who have had an otherwise cryptogenic ischemic stroke, does percutaneous PFO closure reduce the risk of stroke recurrence compared with medical therapy alone?
In patients with a PFO who have had an otherwise cryptogenic ischemic stroke, does anticoagulation reduce the risk of stroke recurrence compared with antiplatelet medication? This update does not address management of stroke risk factors or causes aside from PFO.