PFO closure for secondary stroke prevention: is the discussion closed?

Three previous reports of PFO closure for secondary stroke prevention failed to find any significant benefit. Recently however, three conflicting reports were published suggesting a benefit in select patients. Although we are enthusiastic for PFO closure in appropriate patients, caution is warranted in the extrapolation of this data and the application of this intervention to broader patient groups. Only small minorities of stroke patients are likely to benefit from PFO closure, the intervention has a notable complication rate, and it has not been compared against modern anticoagulation options. Clinicians should consider all of these points as discussions around PFO closure are likely to become more and more common going forward.