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Cryptogenic Stroke – PFO Closure — SCE Neurology MCQ

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HardCerebrovascular DiseaseCryptogenic Stroke – PFO ClosureSCE Neurology

A 44-year-old develops a small non-disabling hemispheric infarct from extracranial internal-carotid dissection. There is no intraluminal thrombus, pseudoaneurysm or recurrent embolism, and no competing indication for anticoagulation. What is a reasonable initial strategy?

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Correct answer: E — Use antiplatelet therapy with specialist follow-up and interval vascular imaging

For extracranial arterial dissection causing ischaemic stroke, NICE permits either antiplatelet or anticoagulant treatment; in this uncomplicated case antiplatelet therapy is reasonable because no feature clearly favours anticoagulation. Weekly imaging, indefinite dual therapy and routine stenting add burden or risk without an indication. Follow-up should be individualised in a neurovascular service.

Reference: NICE NG128 stroke and transient ischaemic attack: recommendations (Current NICE recommendations; reviewed March 2026): https://www.nice.org.uk/guidance/ng128/chapter/Recommendations