Closure of patent foramen ovale after a TIA or minor ischaemic stroke; yet another logical, but unnecessary treatment]

Recently, three randomised clinical trials have demonstrated that percutaneous closure of a patent foramen ovale (PFO) should not routinely be recommended for patients with a TIA or a minor ischaemic stroke, which was deemed to be caused by a PFO. Although the procedure is feasible and carries a low complication rate, it should be considered unnecessary in most patients, because of its benign prognosis with respect to future ischaemic stroke during optimal medical therapy. Cardiologists and neurologists have the difficult task of identifying the few patients with a TIA or minor ischaemic stroke who might benefit from closure of a PFO. Possibly, the procedure should be performed only in patients with recurrent cerebral ischaemic events, a large right-to-left shunt and a relatively high risk for deep venous thrombosis.