What are the recommendations for secondary stroke prevention in a patient with a PFO?
The recommendations for secondary stroke prevention in a patient with a PFO should be based on joint input from a neurologist with expertise in vascular neurology and a cardiologist with expertise in PFO closure. Although one small trial with 120 patients did include some patients over 60 years of age, this should not be construed as randomized clinical trial evidence of benefit in this age group; therefore, this procedure should rarely be performed in older patients and only in very unusual clinical circumstances. It is essential that a thorough evaluation has been completed and that there is no alternative cause of the stroke. All that showed benefit from PFO closure excluded lacunar strokes. Thus, the requirement that the stroke be cryptogenic is equivalent to nonlacunar stroke of undetermined source, or ESUS.