In patients older than 60, PFO closure showed a lower incidence of recurrent ischemic stroke (3.9%) compared to controls (8.2%) after 5 years, with 1% complication rate.
Does patent foramen ovale (PFO) closure reduce recurrent ischemic stroke in patients older than 60 years with embolic stroke of undetermined source (ESUS) or cryptogenic stroke?
In patients over 60 with cryptogenic stroke or ESUS, PFO closure is safe and demonstrates a non-significant trend toward reducing recurrent ischemic stroke compared to age-matched controls.
Objective: Patent foramen ovale (PFO) closure is recommended for patients younger than 60 years with embolic stroke of undetermined source (ESUS) or cryptogenic stroke, but it’s role in patients older than 60 years remains unclear. We aim to investigate the benefit of closure in patients older than 60 with ESUS or cryptogenic stroke. Methods: Patients older than 60 years with ESUS or cryptogenic stroke from several large tertiary hospitals were recruited, who received a PFO closure after multidisciplinary brain-heart case conference, compared to age-matched cohort patients with ESUS or cryptogenic stroke. The primary outcome included recurrent ischemic stroke that occurred up to a median follow up of 5 years following PFO closure between two groups. The safety outcome was the occurrence of any complications after PFO closure, including new onset atrial fibrillation (AF). Results: A total of 102 patients (Table 1) were included (mean age 66±4), 56 male (55%), who received a PFO closure. Procedure-related complications, including new onset transient AF were low (1%). After following patients up to 5 years, patients with PFO closure demonstrated a relatively low incidence of recurrent ischemic stroke (3.9%, 4/102), compared to age-matched control cohort with a total of 97 patients (mean age 67±4), which had higher incidence of stroke recurrency (8.2%, 8/97) (Table 2). Kaplan-Meier event curve (Figure 1) reveals a trend of reducing recurrent stroke in patients with PFO closure but not achieved statistical significance. Conclusions: In patients with cryptogenic stroke or ESUS who are older than 60 years, PFO closure demonstrated safety profiles with a noticeable trend of reducing recurrent ischemic stroke compared to their age-matched counterparts. Prospective randomized trials are warranted in this young-older population.
Aissa et al. (2026) studied this question. In patients older than 60, PFO closure showed a lower incidence of recurrent ischemic stroke (3.9%) compared to controls (8.2%) after 5 years, with 1% complication rate.