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PFO Closure – CLOSE/RESPECT Trials — SCE Neurology MCQ

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ModerateCerebrovascular DiseasePFO Closure – CLOSE/RESPECT TrialsSCE Neurology

A 55-year-old man with cryptogenic ischaemic stroke and a patent foramen ovale (PFO) detected on bubble echocardiography asks about PFO closure. What did the CLOSE and RESPECT trials show?

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Correct answer: A — PFO closure (endovascular device) combined with antiplatelet therapy reduces the risk of recurrent stroke compared with medical therapy alone in selected patients aged <60 with cryptogenic stroke and PFO — the NNT is approximately 20–30 over 5 years

The CLOSE, RESPECT, and REDUCE trials showed that endovascular PFO closure reduces recurrent stroke risk in patients <60 with cryptogenic stroke and a moderate-to-large PFO (or PFO with atrial septal aneurysm). The absolute risk reduction is modest (NNT ~20–30), and patient selection is critical. NICE IPG371 and RCP guidelines support PFO closure in selected patients after multidisciplinary review. A: Proven benefit in selected patients. C: Risk is reduced, not eliminated. D: Only for cryptogenic stroke patients. E: Antiplatelet therapy is the standard comparator.

Reference: CLOSE Trial (2017); RESPECT Extended Follow-Up; NICE IPG371