PFO closure: Where are the neurologists?

Key Points A meta-analysis of five randomized controlled trials of closure of patent foramen ovale (PFO) versus medical therapy to prevent recurrent stroke shows a statistically significant absolute 2% decrease in recurrent stroke but no difference in death. Patients treated with PFO closure have an absolute 2% increase in the risk of atrial fibrillation, usually transient, after the procedure, as well as increased risk of procedural complications, which are usually minor. Guidelines on PFO closure were written before most data in this meta-analysis were available. Those guidelines are now outdated.