{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:12:10Z","timestamp":1785798730115,"version":"3.56.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T00:00:00Z","timestamp":1716163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Patent Foramen Ovale (PFO) is a common congenital atrial septal defect present in 20%\u201335% of the general population. Although generally considered a benign anatomic variant, a PFO may facilitate passage of a thrombus from the venous to arterial circulation, thereby resulting in cryptogenic stroke or systemic embolization. A PFO is detected in nearly one half of patients presenting with cryptogenic stroke and often considered the most likely etiology when other causes have been excluded. In this review, we discuss the contemporary role of transcatheter closure of PFO in the treatment of cryptogenic stroke, including devices currently available for commercial use in the United States (Amplatzer PFO<jats:sup>TM<\/jats:sup> Occluder and Gore<jats:sup>TM<\/jats:sup> Cardioform Septal Occluder) and a novel suture-mediated device (NobleStitch<jats:sup>TM<\/jats:sup> EL) under clinical investigation. To provide the best care for cryptogenic stroke patients, practitioners should be familiar with the indications for PFO closure and corresponding treatment options.<\/jats:p>","DOI":"10.3389\/fcvm.2024.1391886","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T04:29:37Z","timestamp":1716179377000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Transcatheter PFO closure for cryptogenic stroke: current approaches and future considerations"],"prefix":"10.3389","volume":"11","author":[{"given":"Moemen","family":"Eltelbany","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghav","family":"Gattani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Araba","family":"Ofosu-Somuah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Damluji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly C.","family":"Epps","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne B.","family":"Batchelor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1038\/nrcardio.2010.224","article-title":"Patent foramen ovale: anatomy, outcomes, and closure","volume":"8","author":"Calvert","year":"2011","journal-title":"Nat Rev Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.15420\/icr.2019.27","article-title":"Patent foramen Ovale closure: state of the art","volume":"15","author":"Giblett","year":"2020","journal-title":"Interv Cardiol"},{"key":"B3","doi-asserted-by":"publisher","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":"B4","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart disease and stroke statistics-2019 update: a report from the American heart association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1159\/000216301","article-title":"Studies of Org 10172 in patients with acute ischemic stroke. TOAST study group","volume":"22","author":"Adams","year":"1992","journal-title":"Haemostasis"},{"key":"B6","doi-asserted-by":"publisher","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":"B7","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1212\/WNL.0b013e3182a08d59","article-title":"An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke","volume":"81","author":"Kent","year":"2013","journal-title":"Neurology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1212\/WNL.0000000000000589","article-title":"Recurrent stroke predictors differ in medically treated patients with pathogenic vs. other PFOs","volume":"83","author":"Thaler","year":"2014","journal-title":"Neurology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"281","DOI":"10.3389\/fneur.2020.00281","article-title":"Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review","volume":"11","author":"Koutroulou","year":"2020","journal-title":"Front Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.1161\/01.STR.0000085828.67563.42","article-title":"Race-ethnic differences in patent foramen ovale, atrial septal aneurysm, and right atrial anatomy among ischemic stroke patients","volume":"34","author":"Rodriguez","year":"2003","journal-title":"Stroke"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2277","DOI":"10.1001\/jama.2021.20956","article-title":"Heterogeneity of treatment effects in an analysis of pooled individual patient data from randomized trials of device closure of patent foramen ovale after stroke","volume":"326","author":"Kent","year":"2021","journal-title":"JAMA"},{"key":"B12","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1056\/NEJMoa1009639","article-title":"Closure or medical therapy for cryptogenic stroke with patent foramen ovale","volume":"366","author":"Furlan","year":"2012","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1056\/NEJMoa1211716","article-title":"Percutaneous closure of patent foramen ovale in cryptogenic embolism","volume":"368","author":"Meier","year":"2013","journal-title":"N Engl J Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1056\/NEJMe1301680","article-title":"Still no closure on the question of PFO closure","volume":"368","author":"Messe","year":"2013","journal-title":"N Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3147","DOI":"10.1161\/STROKEAHA.112.659599","article-title":"Critique of closure or medical therapy for cryptogenic stroke with patent foramen ovale: the hole truth?","volume":"43","author":"Thaler","year":"2012","journal-title":"Stroke"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1056\/NEJMoa1301440","article-title":"Closure of patent foramen ovale versus medical therapy after cryptogenic stroke","volume":"368","author":"Carroll","year":"2013","journal-title":"N Engl J Med"},{"key":"B17","doi-asserted-by":"publisher","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":"B18","doi-asserted-by":"publisher","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":"B19","doi-asserted-by":"publisher","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":"B20","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1016\/j.jacc.2018.02.046","article-title":"Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial","volume":"71","author":"Lee","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2228","DOI":"10.1016\/j.jcin.2017.09.002","article-title":"Transcatheter patent foramen ovale closure after cryptogenic stroke: an updated meta-analysis of randomized trials","volume":"10","author":"Mojadidi","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"B22","doi-asserted-by":"publisher","first-page":"100337","DOI":"10.1016\/j.jscai.2022.100039","article-title":"SCAI guidelines for the management of patent foramen ovale","volume":"1","author":"Kavinsky","year":"2022","journal-title":"J Soc Cardiovasc Angiography Interv"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American heart association\/American stroke association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"B24","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1017\/cjn.2021.127","article-title":"Canadian stroke best practice recommendations: secondary prevention of stroke update 2020","volume":"49","author":"Gladstone","year":"2022","journal-title":"Can J Neurol Sci"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e367","DOI":"10.4244\/EIJ-D-20-00785","article-title":"European position paper on the management of patients with patent foramen ovale. Part II\u2014decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions","volume":"17","author":"Pristipino","year":"2021","journal-title":"EuroIntervention"},{"key":"B26","doi-asserted-by":"publisher","first-page":"3119","DOI":"10.1161\/STROKEAHA.120.029350","article-title":"Risk of paradoxical embolism (RoPE)-estimated attributable fraction correlates with the benefit of patent foramen ovale closure: an analysis of 3 trials","volume":"51","author":"Kent","year":"2020","journal-title":"Stroke"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1161\/CIRCULATIONAHA.117.033456","article-title":"Patent foramen ovale closure: the pendulum swings","volume":"137","author":"Hankey","year":"2018","journal-title":"Circulation"},{"key":"B28","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1177\/1747493017701152","article-title":"Patent foramen ovale closure with GORE HELEX or CARDIOFORM septal occluder vs. antiplatelet therapy for reduction of recurrent stroke or new brain infarct in patients with prior cryptogenic stroke: design of the randomized gore REDUCE clinical study","volume":"12","author":"Kasner","year":"2017","journal-title":"Int J Stroke"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.1212\/WNL.0000000000005739","article-title":"Percutaneous patent foramen ovale closure for secondary stroke prevention: network meta-analysis","volume":"91","author":"Tsivgoulis","year":"2018","journal-title":"Neurology"},{"key":"B30","first-page":"182","article-title":"The occlutech figulla PFO and ASD occluder: a new nitinol wire mesh device for closure of atrial septal defects","volume":"22","author":"Krizanic","year":"2010","journal-title":"J Invasive Cardiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"131116","DOI":"10.1016\/j.ijcard.2023.06.007","article-title":"Patent foramen ovale closure with the occlutech figulla flex II device: a long-term (up to 10-years) follow-up","volume":"387","author":"Trabattoni","year":"2023","journal-title":"Int J Cardiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC guidelines for the management of adult congenital heart disease","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur Heart J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1161\/CIRCINTERVENTIONS.108.810507","article-title":"Immunohistochemical characterization of neotissues and tissue reactions to septal defect-occlusion devices","volume":"2","author":"Foth","year":"2009","journal-title":"Circ Cardiovasc Interv"},{"key":"B34","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1159\/000113427","article-title":"Atrial fibrillation following device closure of patent foramen ovale","volume":"111","author":"Burow","year":"2008","journal-title":"Cardiology"},{"key":"B35","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/2047-783X-16-1-13","article-title":"Risk and fate of residual interatrial shunting after transcatheter closure of patent foramen ovale: a long term follow up study","volume":"16","author":"Hammerstingl","year":"2011","journal-title":"Eur J Med Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e272","DOI":"10.4244\/EIJ-D-18-00023","article-title":"Novel percutaneous suture-mediated patent foramen ovale closure technique: early results of the NobleStitch EL Italian registry","volume":"14","author":"Gaspardone","year":"2018","journal-title":"EuroIntervention"},{"key":"B37","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1053\/j.jvca.2022.10.014","article-title":"Noblestitch patent foramen ovales closure for recurrent strokes in a patient with COVID-19 on extracorporeal membrane oxygenation","volume":"37","author":"Stout","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ehjcr\/ytaa162","article-title":"A severe right-to-left intracardiac shunt after NobleStitch failure: when a device is needed","volume":"4","author":"Trabattoni","year":"2020","journal-title":"Eur Heart J Case Rep"},{"key":"B39","doi-asserted-by":"publisher","first-page":"68","DOI":"10.4244\/EIJ-D-21-01021","article-title":"Mechanisms of ineffective patent foramen ovale closure using the percutaneous suture-mediated NobleStitch system","volume":"18","author":"Zannoni","year":"2022","journal-title":"EuroIntervention"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2023.10.004","article-title":"Percutaneous suture-based patent foramen ovale closure: a state-of-the-art review","author":"Cannata","year":"2023","journal-title":"Trends Cardiovasc Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2112","DOI":"10.1016\/j.jcin.2020.06.004","article-title":"Predictors of residual right-to-left shunt after percutaneous suture-mediated patent fossa ovalis closure","volume":"13","author":"Gaspardone","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.1016\/j.jcin.2019.05.040","article-title":"Interatrial septal tear after patent foramen ovale closure with the NobleStitch device","volume":"12","author":"Baldetti","year":"2019","journal-title":"JACC Cardiovasc Interv"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1391886\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T04:29:39Z","timestamp":1716179379000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1391886\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,20]]},"references-count":42,"alternative-id":["10.3389\/fcvm.2024.1391886"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1391886","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,20]]},"article-number":"1391886"}}