Management of Patent Foramen Ovale

Publication Date: May 19, 2022
Last Updated: June 7, 2022

Percutaneous PFO closure versus medical therapy (antiplatelet or anticoagulation or composite)/no therapy in adults without a prior PFO-associated stroke

In persons experiencing migraines without a prior PFO-associated stroke, the SCAI guideline panel suggests against the routine use of PFO closure for the treatment of migraine. (C, M)
Remarks: Patients, particularly those with debilitating migraines who have failed to benefit from conventional medical therapy, who place a high value on the uncertain benefits of having their PFO closed and a lower value on the uncertain harms, may reasonably choose PFO closure.

Percutaneous PFO closure versus antiplatelet therapy in adults with a prior PFO-associated stroke

In patients between the ages of 18 and 60 with a prior PFO-associated stroke, the SCAI guideline panel recommends PFO closure rather than antiplatelet therapy alone. (S, M)
Remark: This recommendation is independent of patient anatomy (ie, presence of ASA, size of shunt) due to limited clinical data on these sub-populations. A RoPE (risk of paradoxical embolism) score ≥7 may identify patients who are likely to receive greater benefit from PFO closure.

This recommendation also applied to patients with high-risk anatomy (ie, ASA) and patients evaluated with a RoPE score.



Management of Patent Foramen Ovale

Authoring Organization