SCAI Management of Patent Foramen Ovale Guideline Summary

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.

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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

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

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

Overview

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