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PFO Closure Evidence — EECC MCQ

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ModerateGeneral CardiologyPFO Closure EvidenceEECC

A 45-year-old woman with known PFO and cryptogenic stroke is being assessed for PFO closure. What does the current evidence show about PFO closure for secondary stroke prevention?

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Correct answer: C — Three RCTs (CLOSE, RESPECT extended, REDUCE) showed PFO closure plus antiplatelet therapy reduced recurrent stroke compared with antiplatelet therapy alone in patients <60 with cryptogenic stroke and moderate-high risk PFO features (large shunt, atrial septal aneurysm); NNT is approximately 20-30 over 5 years

PFO closure for secondary prevention of cryptogenic stroke: three pivotal RCTs (CLOSE 2017, RESPECT extended 2017, REDUCE 2017) all demonstrated superiority of PFO closure + antiplatelet therapy over medical therapy alone for reducing recurrent stroke in patients aged <60 with cryptogenic stroke and PFO with high-risk features (large shunt/right-to-left flow, atrial septal aneurysm). Key details: (1) NNT ~20-30 over 5 years; (2) AF post-closure is a recognized complication (~5-10%, usually transient); (3) patient selection is crucial: best evidence for age <60, cryptogenic stroke after thorough workup excluding other causes, PFO with high-risk anatomy. The ESC position paper and 2024 AF Guidelines recommend PFO closure for appropriately selected patients (shared decision with stroke neurology). Older patients (>60) and those with low-risk PFO anatomy derive less benefit.

Reference: ESC Position Paper on PFO Closure; CLOSE/RESPECT/REDUCE Trials