{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T03:13:25Z","timestamp":1771643605141,"version":"3.50.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"Supplement_E","license":[{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"vor","delay-in-days":66,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Patent foramen ovale (PFO) is an anatomical communication between the left and the right atrium due to the lack of completed sealing of the fossa ovalis. Epidemiologic data, for the most part derived from young populations studies, suggested that PFO, allowing paradoxical embolization of thrombotic material from the venous to the arterial district, could play a significant role in the pathogenesis of cryptogenic ischaemic cerebral events. Recently, three randomized studies in patients \u226460\u2009years of age demonstrated the superiority of percutaneous closure of PFO over medical antithrombotic treatment. Several studies, on the other hand, indicated that also in older patients with cryptogenic cerebral ischaemia, there was an higher prevalence of PFO in patients at low atherosclerosis and cardioembolic risk, and increased incidence of adverse cerebral events (mostly cryptogenic in patients treated medically, but likely due to a new cause in patients who had percutaneous closure of PFO). Advanced age is associated with more risk factors for deep vein thrombosis, and consequent paradoxical embolization through the PFO, so much so that careful consideration should be given to patients over the age of 60 years with cryptogenic stroke, as to not forgo the benefit of percutaneous closure of PFO, merely for anagraphic consideration. This consideration is particularly poignant in light of the more recent technical advances now available, such as direct percutaneous suture, mostly appealing for elderly patients, for its better tolerability and high safety both peri-procedural and during the follow-up, as well as the lack of necessity for antithrombotic treatment.<\/jats:p>","DOI":"10.1093\/eurheartj\/suaa067","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T09:12:16Z","timestamp":1591261936000},"page":"E82-E86","source":"Crossref","is-referenced-by-count":8,"title":["Cryptogenic stroke over 60 years of age: should patent foramen ovale be closed?"],"prefix":"10.1093","volume":"22","author":[{"given":"Achille","family":"Gaspardone","sequence":"first","affiliation":[{"name":"U.O.C. Cardiologia, Ospedale S. Eugenio, Roma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory A","family":"Sgueglia","sequence":"first","affiliation":[{"name":"U.O.C. Cardiologia, Ospedale S. Eugenio, Roma"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,3,30]]},"reference":[{"key":"2020060405101448800_suaa067-B1","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1056\/NEJMoa1707404","article-title":"Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke","volume":"377","author":"Sondergaard","year":"2017","journal-title":"N Engl J Med"},{"key":"2020060405101448800_suaa067-B2","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1056\/NEJMoa1610057","article-title":"Long-term outcomes of patent foramen ovale closure or medical therapy after stroke","volume":"377","author":"Saver","year":"2017","journal-title":"N Engl J Med"},{"key":"2020060405101448800_suaa067-B3","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMoa1705915","article-title":"Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke","volume":"377","author":"Mas","year":"2017","journal-title":"N Engl J Med"},{"key":"2020060405101448800_suaa067-B4","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1212\/WNL.55.8.1172","article-title":"Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies","volume":"55","author":"Overell","year":"2000","journal-title":"Neurology"},{"key":"2020060405101448800_suaa067-B5","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1056\/NEJMoa071422","article-title":"Patent foramen ovale and cryptogenic stroke in older patients","volume":"357","author":"Handke","year":"2007","journal-title":"N Engl J Med"},{"key":"2020060405101448800_suaa067-B6","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S1474-4422(18)30167-4","article-title":"Pevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis","volume":"17","author":"Mazzucco","year":"2018","journal-title":"Lancet Neurol"},{"key":"2020060405101448800_suaa067-B7","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S1474-4422(15)00132-5","article-title":"Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study","volume":"14","author":"Li","year":"2015","journal-title":"Lancet Neurol"},{"key":"2020060405101448800_suaa067-B8","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/s41582-018-0050-7","article-title":"Patent foramen ovale increases stroke risk in older people","volume":"14","author":"Mattle","year":"2018","journal-title":"Nat Rev Neurol"},{"key":"2020060405101448800_suaa067-B9","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1161\/01.STR.0000135773.24116.18","article-title":"Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen 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