What is the recommendation for secondary stroke prevention in a patient with a PFO?
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 (Figure 5).563,564 Although 1 small trial with 120 patients did include some patients >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 clo- sure excluded lacunar strokes. Thus, the require- ment that the stroke be cryptogenic is equivalent to nonlacunar stroke of undetermined source, or ESUS.