What is the best way to treat cryptogenic stroke with patent foramen ovale?
Clinical trials have generally found that closure of the patent foramen ovale (PFO) is more effective than anticoagulant or antiplatelet therapy in reducing the risk of recurrent stroke in patients with cryptogenic stroke and PFO. However, anticoagulant or antiplatelet therapy may be preferable in certain circumstances, such as for those with poor tolerance to anticoagulants or who cannot tolerate transcatheter closure. A systematic review and meta-analysis of randomized trials found that transcatheter closure was associated with a significantly lower risk of recurrent stroke and less major adverse events compared to medical therapy. Another meta-analysis found that PFO closure was superior to medical therapy in reducing the risk of recurrent stroke, but was associated with a higher risk of device-related adverse events. Ultimately, the decision of which treatment is most appropriate for a given patient should be based on an individual assessment of the patient's risk factors and preferences.  