Young people with a history of strokes caused by blood clots should be evaluated for a patent foramen ovale (PFO) closure, according to Hooman Kamel, MD, a neurologist with expertise in stroke at NewYork-Presbyterian/Weill Cornell. In an editorial published in JAMA Neurology in February 2018, Dr. Kamel argues that data from recent clinical trials confirms that PFO closure should be considered in certain stroke patients. “Clinicians can now make recommendations with much more certainty about the risks and benefits, and eligible patients have an additional proven treatment option for preventing stroke,” says Dr. Kamel.

“Presence of a PFO alone is not enough reason to close. We work together with our colleagues in neurology to evaluate every patient.” — Dr. Harsimran S. Singh

PFO, which happens in about 25 percent of the population, is a risk factor for ischemic stroke. Whether or not surgical closure of a PFO prevents stroke has long been a matter of debate among physicians.

According to Dr. Kamel, recent research shows that PFO closure should be considered only in patients under 60 who have had an ischemic stroke that has no other apparent cause. PFO closure should not be offered to patients with other types of stroke or to those with transient ischemic attack. It is also important to note, says Dr. Kamel, that PFO should not automatically be considered the cause of an ischemic stroke. “Before agreeing to PFO closure, patients should ask whether their profile fits the profile of patients in the clinical trials,” he says. “If it does not, there is no knowing whether PFO closure will lead to more benefit than harm.”

At Weill Cornell Medicine and NewYork-Presbyterian, the decision to close a PFO is made in consultation with a multidisciplinary team of neurologists and interventional cardiologists. “A good relationship between the two services is crucial,” says Harsimran S. Singh, MD, an interventional cardiologist at NewYork-Presbyterian/Weill Cornell and the David S. Blumenthal Assistant Professor of Medicine at Weill Cornell Medicine, who performs the PFO closure procedure. “Presence of a PFO alone is not enough reason to close. We work together with our colleagues in neurology to evaluate every patient.”

Even when indicated, PFO closure does not provide lifelong protection against stroke, because patients can develop other risk factors as they age. “When a decision is made to perform PFO closure, our interventional cardiologists have the experience and skill to perform these procedures safely, and our stroke neurologists then provide expert follow-up care,” adds Dr. Kamel. “Patients should receive lifelong monitoring and intensive management of common stroke risk factors.”