REFERENCES
2. Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Front Neurol. 2020;11:281.
3. Mojadidi MK, Zaman MO, Elgendy IY, et al. Cryptogenic stroke and patent foramen ovale. J Am Coll Cardiol. 2018;71:1035-43.
4. Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55:1172-9.
5. Messé SR, Gronseth GS, Kent DM, et al. Practice advisory update summary: patent foramen ovale and secondary stroke prevention: report of the Guideline Subcommittee of the American Academy of Neurology. Neurology. 2020;94:876-85.
6. Rimoldi SF, Ott S, Rexhaj E, et al. Patent foramen ovale closure in obstructive sleep apnea improves blood pressure and cardiovascular function. Hypertension. 2015;66:1050-7.
7. Orsinelli DA, Rajpal S. Doing a deep dive on patent foramen ovale: stay tuned in the PFO World. JACC Cardiovasc Imaging. 2022;15:190-2.
8. Trabattoni D, Brambilla M, Canzano P, et al. Migraine in patients undergoing PFO closure: characterization of a platelet-associated pathophysiological mechanism: The LEARNER study. JACC Basic Transl Sci. 2022;7:525-40.
9. Othman F, Bailey B, Collins N, et al. Platypnea-orthodeoxia syndrome in the setting of patent foramen ovale without pulmonary hypertension or major lung disease. J Am Heart Assoc. 2022;11:e024609.
10. Perera KS, Vanassche T, Bosch J, et al; ESUS Global Registry Investigators. Embolic strokes of undetermined source: prevalence and patient features in the ESUS Global Registry. Int J Stroke. 2016;11:526-33.
11. to: Randomized clinical trial to evaluate an atrial fibrillation stroke prevention shared decision-making pathway. J Am Heart Assoc. 2023;12:e027740.
13. Hart RG, Diener HC, Coutts SB, et al; Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429-38.
14. Ishizuka K, Toi S, Hoshino T, Higuchi E, Kitagawa K. Localization of infratentorial lesion could predict patent foramen ovale as an etiology in embolic stroke of undetermined source. J Atheroscler Thromb. 2022;29:785-93.
16. Bang OY, Lee MJ, Ryoo S, Kim SJ, Kim JW. Patent foramen ovale and stroke-current status. J Stroke. 2015;17:229-37.
17. Katsanos AH, Bhole R, Frogoudaki A, et al. The value of transesophageal echocardiography for embolic strokes of undetermined source. Neurology. 2016;87:988-95.
18. Farjat-Pasos JI, Chamorro A, Lanthier S, et al. Cerebrovascular events in older patients with patent foramen ovale: current status and future perspectives. J Stroke. 2023;25:338-49.
19. Saver JL, Mattle HP, Thaler D. Patent foramen ovale closure versus medical therapy for cryptogenic ischemic stroke: a topical review. Stroke. 2018;49:1541-8.
20. Yan C, Li H. Preliminary investigation of in situ thrombus within patent foramen ovale in patients with and without stroke. JAMA. 2021;325:2116-8.
21. Thaler DE, Ruthazer R, Di Angelantonio E, et al. Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale. Stroke. 2013;44:675-80.
22. Lee OH, Kim JS. Percutaneous patent foramen ovale closure after stroke. Korean Circ J. 2022;52:801-7.
23. Sposato LA, Albin CSW, Elkind MSV, Kamel H, Saver JL. Patent foramen ovale management for secondary stroke prevention: state-of-the-art appraisal of current evidence. Stroke. 2024;55:236-47.
24. Liu F, Kong Q, Zhang X, et al. Comparative analysis of the diagnostic value of several methods for the diagnosis of patent foramen ovale. Echocardiography. 2021;38:790-7.
25. Miki T, Nakagawa K, Ichikawa K, et al. Diagnostic performance of cardiac computed tomography for detecting patent foramen ovale: evaluation using transesophageal echocardiography and catheterization as reference standards. J Cardiovasc Dev Dis. 2023;10:193.
26. Mojadidi MK, Bogush N, Caceres JD, Msaouel P, Tobis JM. Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography. 2014;31:752-8.
27. Mahmoud AN, Elgendy IY, Agarwal N, Tobis JM, Mojadidi MK. Identification and quantification of patent foramen ovale-mediated shunts: echocardiography and transcranial Doppler. Interv Cardiol Clin. 2017;6:495-504.
28. Zhang Y, Zhu R, Yu Z, Hou S, Niu J. Patent foramen ovale-associated stroke repeatedly misdiagnosed as cerebral small vessel disease: a case report. Medicine. 2023;102:e32996.
29. Khan R, Karim MN, Hosseini F, Fine N. Diagnostic accuracy of transthoracic echocardiography with contrast for detection of right-to-left shunt: a systematic review and meta-analysis. Can J Cardiol. 2022;38:1948-58.
30. Palazzo P, Heldner MR, Nasr N, Alexandrov AV. Transcranial Doppler with microbubbles: screening test to detect and grade right-to-left shunt after an ischemic stroke: a literature review. Stroke. 2024;55:2932-41.
31. Mojadidi MK, Roberts SC, Winoker JS, et al. Accuracy of transcranial Doppler for the diagnosis of intracardiac right-to-left shunt: a bivariate meta-analysis of prospective studies. JACC Cardiovasc Imaging. 2014;7:236-50.
32. Alexandrov AV, Sloan MA, Tegeler CH, et al; American Society of Neuroimaging Practice Guidelines Committee. Practice standards for transcranial Doppler (TCD) ultrasound. Part II. Clinical indications and expected outcomes. J Neuroimaging. 2012;22:215-24.
33. De Castro S, Papetti F, Di Angelantonio E, et al. Feasibility and clinical utility of transesophageal echocardiography in the acute phase of cerebral ischemia. Am J Cardiol. 2010;106:1339-44.
35. Song JK. Pearls and Pitfalls in the transesophageal echocardiographic diagnosis of patent foramen ovale. J Am Soc Echocardiogr. 2023;36:895-905.e3.
36. Yan C, Li H, Wang C, et al. Frequency and size of in situ thrombus within patent foramen ovale. Stroke. 2023;54:1205-13.
37. Rinkel LA, Bouma BJ, Boekholdt SM, et al. Detection of patent foramen ovale in patients with ischemic stroke on prospective ECG-gated cardiac CT compared to transthoracic echocardiography. J Neurol. 2023;270:3537-42.
38. Lee S, Kim IC, Kim YD, et al. The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke. Eur Radiol. 2021;31:8983-90.
39. Meinel TR, Eggimann A, Brignoli K, et al. Cardiovascular MRI compared to echocardiography to identify cardioaortic sources of ischemic stroke: a systematic review and meta-analysis. Front Neurol. 2021;12:699838.
40. Mojadidi MK, Mahmoud AN, Elgendy IY, Agarwal N, Tobis JM. Transesophageal echocardiography for the detection of patent foramen ovale. J Am Soc Echocardiogr. 2017;30:933-4.
41. Shi F, Sha L, Li H, et al. Recent progress in patent foramen ovale and related neurological diseases: a narrative review. Front Neurol. 2023;14:1129062.
42. Gallagher J, Dawdy J, Afonso L. Overcoming a stubborn patent foramen ovale. Echocardiography. 2023;40:1151-5.
43. Katsanos AH, Psaltopoulou T, Sergentanis TN, et al. Transcranial Doppler versus transthoracic echocardiography for the detection of patent foramen ovale in patients with cryptogenic cerebral ischemia: a systematic review and diagnostic test accuracy meta-analysis. Ann Neurol. 2016;79:625-35.
44. Nygren AT, Jogestrand T. Detection of patent foramen ovale by transcranial Doppler and carotid duplex ultrasonography: a comparison with transoesophageal echocardiography. Clin Physiol. 1998;18:327-30.
45. Van H, Poommipanit P, Shalaby M, Gevorgyan R, Tseng CH, Tobis J. Sensitivity of transcranial Doppler versus intracardiac echocardiography in the detection of right-to-left shunt. JACC Cardiovasc Imaging. 2010;3:343-8.
46. Ji MH, Seoung YH. Right-to-left shunt evaluation in cardiac patent foramen ovale using bubble contrast transcranial color-coded Doppler: a cryptogenic stroke case. Healthcare. 2023;11:2655.
47. Pristipino C, Sievert H, D’Ascenzo F, et al; Evidence Synthesis Team, Eapci Scientific Documents and Initiatives Committee, International Experts. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J. 2019;40:3182-95.
48. Souteyrand G, Motreff P, Lusson JR, et al. Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients. Eur J Echocardiogr. 2006;7:147-54.
49. Katsanos AH, Spence JD, Bogiatzi C, et al. Recurrent stroke and patent foramen ovale: a systematic review and meta-analysis. Stroke. 2014;45:3352-9.
50. Albart SA, Yusof Khan AHK, Wan Zaidi WA, et al. Management of patent foramen ovale in embolic stroke of undetermined source patients: Malaysian experts’ consensus. Med J Malaysia. 2023;78:389-403.
51. Strambo D, Sirimarco G, Nannoni S, et al. Embolic stroke of undetermined source and patent foramen ovale: risk of paradoxical embolism score validation and atrial fibrillation prediction. Stroke. 2021;52:1643-52.
52. Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013;81:619-25.
53. Yao Q, Xiong H, Zhang D, et al. Synchronous multimode ultrasound for assessing right-to-left shunt: a prospective clinical study. Front Neurol. 2023;14:1148846.
54. Kent DM, Saver JL, Ruthazer R, et al. Risk of paradoxical embolism (RoPE)-estimated attributable fraction correlates with the benefit of patent foramen ovale closure: an analysis of 3 trials. Stroke. 2020;51:3119-23.
55. Mas JL, Derex L, Guérin P, et al. Transcatheter closure of patent foramen ovale to prevent stroke recurrence in patients with otherwise unexplained ischaemic stroke: expert consensus of the French Neurovascular Society and the French Society of Cardiology. Arch Cardiovasc Dis. 2019;112:532-42.
56. Elgendy AY, Saver JL, Amin Z, et al. Proposal for updated nomenclature and classification of potential causative mechanism in patent foramen ovale-associated stroke. JAMA Neurol. 2020;77:878-86.
57. Kent DM, Saver JL, Kasner SE, et al. Heterogeneity of treatment effects in an analysis of pooled individual patient data from randomized trials of device closure of patent foramen ovale after stroke. JAMA. 2021;326:2277-86.
58. Kanemaru K, Ueno Y, Kikuno M, et al. High-risk patent foramen ovale and elderly in cryptogenic stroke. J Stroke Cerebrovasc Dis. 2023;32:107344.
59. Ter Schiphorst A, Lippi A, Corti L, et al. In young patients with stroke of undetermined etiology, large vessel occlusions are less frequent in the group with high-risk patent foramen ovale. Rev Neurol. 2024;180:539-47.
60. Mas JL, Saver JL, Kasner SE, et al. Association of atrial septal aneurysm and shunt size with stroke recurrence and benefit from patent foramen ovale closure. JAMA Neurol. 2022;79:1175-9.
61. Rigatelli G, Zuin M, Bilato C. Atrial septal aneurysm contribution to the risk of cryptogenic stroke in patients with patent foramen ovale: a brief updated systematic review and meta-analysis. Trends Cardiovasc Med. 2023;33:329-33.
62. Immens MH, van den Hoeven V, van Lith TJ, Duijnhouwer TD, Ten Cate TJ, de Leeuw FE. Heart-Stroke Team: a multidisciplinary assessment of patent foramen ovale-associated stroke. Eur Stroke J. 2024;9:219-25.
63. Pu H, Zhang Q, Wu J, Zhang Y, Zhao Y, Li L. Assessment of the characteristics of patent foramen ovale associated with cryptogenic stroke. Curr Med Imaging. 2024;20:e15734056284889.
64. Brown KN, ElBebawy B, Shah AH, Kanmanthareddy A. Catheter management of patent foramen ovale. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537314/. [Last accessed on 20 May 2025].
65. Kolte D, Palacios IF. Patent foramen ovale closure for secondary prevention of cryptogenic stroke. Expert Rev Cardiovasc Ther. 2021;19:211-20.
66. Saver JL, Carroll JD, Thaler DE, et al; RESPECT Investigators. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377:1022-32.
67. Mas JL, Derumeaux G, Guillon B, et al; CLOSE Investigators. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011-21.
68. Søndergaard L, Kasner SE, Rhodes JF, et al; Gore REDUCE Clinical Study Investigators. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377:1033-42.
69. Lee PH, Song JK, Kim JS, et al. Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial. J Am Coll Cardiol. 2018;71:2335-42.
70. Sá MPBO, Oliveira Neto LAP, Nascimento GCSD, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke: meta-analysis of five randomized controlled trials with 3440 patients. Braz J Cardiovasc Surg. 2018;33:89-98.
71. Akobeng AK, Abdelgadir I, Boudjemline Y, Hijazi ZM. Patent foramen ovale (PFO) closure versus medical therapy for prevention of recurrent stroke in patients with prior cryptogenic stroke: a systematic review and meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv. 2018;92:165-73.
72. Wang TKM, Wang MTM, Ruygrok P. Patent foramen ovale closure versus medical therapy for cryptogenic stroke: meta-analysis of randomised trials. Heart Lung Circ. 2019;28:623-31.
73. Patel U, Dengri C, Pielykh D, et al; Renu. Secondary prevention of cryptogenic stroke and outcomes following surgical patent foramen ovale closure plus medical therapy vs. medical therapy alone: an umbrella meta-analysis of eight meta-analyses covering seventeen countries. Cardiol Res. 2023;14:342-50.
74. Ahmad Y, Howard JP, Arnold A, et al. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials. Eur Heart J. 2018;39:1638-49.
75. Furlan AJ, Reisman M, Massaro J, et al; CLOSURE I Investigators. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012;366:991-9.
76. Meier B, Kalesan B, Mattle HP, et al; PC Trial Investigators. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013;368:1083-91.
77. Leppert MH, Poisson SN, Carroll JD, et al. Cost-effectiveness of patent foramen ovale closure versus medical therapy for secondary stroke prevention. Stroke. 2018;49:1443-50.
78. Maloku A, Hamadanchi A, Günther A, Aftanski P, Schulze PC, Möbius-Winkler S. Patent foramen ovale (PFO): history, diagnosis, and management. Rev Cardiovasc Med. 2024;25:422.
79. Caso V, Turc G, Abdul-Rahim AH, et al. European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke. Eur Stroke J. 2024;9:800-34.
80. Randhawa S, Mehta JL, Dhar G. Percutaneous patent foramen ovale closure: stroke and beyond. Curr Cardiol Rev. 2024;20:77-86.
81. Chen PL, Wang CS, Huang JA, et al. Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study. Front Neurol. 2023;14:1190011.
82. Takafuji H, Hosokawa S, Ogura R, Hiasa Y. Percutaneous transcatheter closure of high-risk patent foramen ovale in the elderly. Heart Vessels. 2019;34:1657-62.
83. Gili S, Calligaris G, Teruzzi G, et al. Patent foramen ovale occlusion in elderly patients: is it worth it? A large, single-center retrospective analysis. J Clin Med. 2024;13:3514.
84. Lee PH, Kim JS, Song JK, et al. Device closure or antithrombotic therapy after cryptogenic stroke in elderly patients with a high-risk patent foramen ovale. J Stroke. 2024;26:242-51.
85. Alperi A, Guedeney P, Horlick E, et al. Transcatheter closure of patent foramen ovale in older patients with cryptogenic thromboembolic events. Circ Cardiovasc Interv. 2022;15:e011652.
86. Eichelmann A, Kubini R, Nachoski D, Kosinski C, Becker M, Aljalloud A. Patent foramen ovale closure versus drug therapy in patients over 60 years and a follow-up of 5 years. Clin Cardiol. 2024;47:e24251.
87. Wang AY, Rothwell PM, Nelson J, et al. Patent foramen ovale closure in older patients with stroke: patient selection for trial feasibility. Neurology. 2024;103:e209727.
88. Elzanaty AM, Patel N, Sabbagh E, Eltahawy EA. Patent foramen ovale closure in the management of cryptogenic stroke: a review of current literature and guideline statements. Curr Med Res Opin. 2021;37:377-84.
89. Pietzsch JB, Geisler BP, Daniels MJ, et al. An assessment of annual procedure volumes and therapy adoption of transcatheter closure of patent foramen ovale in four European countries. Eur Stroke J. 2021;6:72-80.
90. Quesada O, Van Hon L, Yildiz M, et al. Sex differences in clinical characteristics, management strategies, and outcomes of STEMI with COVID-19: NACMI registry. J Soc Cardiovasc Angiogr Interv. 2022;1:100360.
91. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52:e364-467.
92. Guedeney P, Farjat-Pasos JI, Asslo G, et al; AIR-FORCE Task Force. Impact of the antiplatelet strategy following patent foramen ovale percutaneous closure. Eur Heart J Cardiovasc Pharmacother. 2023;9:601-7.
93. Bejjani A, Khairani CD, Assi A, et al. When direct oral anticoagulants should not be standard treatment: JACC state-of-the-art review. J Am Coll Cardiol. 2024;83:444-65.
94. Kavinsky CJ, Szerlip M, Goldsweig AM, et al. SCAI Guidelines for the management of patent foramen ovale. J Soc Cardiovasc Angiogr Interv. 2022;1:100039.
95. Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP; PFO in Cryptogenic Stroke Study (PICSS) Investigators. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002;105:2625-31.
96. Hart RG, Sharma M, Mundl H, et al; NAVIGATE ESUS Investigators. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018;378:2191-201.
97. Diener HC, Sacco RL, Easton JD, et al; RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for prevention of stroke after embolic stroke of undetermined source. N Engl J Med. 2019;380:1906-17.
98. Kamel H, Longstreth WT Jr, Tirschwell DL, et al; ARCADIA Investigators. Apixaban to prevent recurrence after cryptogenic stroke in patients with atrial cardiopathy: the ARCADIA randomized clinical trial. JAMA. 2024;331:573-81.
99. Geisler T, Keller T, Martus P, et al; ATTICUS Investigators. Apixaban versus aspirin for embolic stroke of undetermined source. NEJM Evid. 2024;3:EVIDoa2300235.
100. Kasner SE, Swaminathan B, Lavados P, et al; NAVIGATE ESUS Investigators. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol. 2018;17:1053-60.
101. Diener HC, Chutinet A, Easton JD, et al. Dabigatran or aspirin after embolic stroke of undetermined source in patients with patent foramen ovale: results from RE-SPECT ESUS. Stroke. 2021;52:1065-8.
102. Alkhouli M, Sievert H, Holmes DR. Patent foramen ovale closure for secondary stroke prevention. Eur Heart J. 2019;40:2339-50.
103. Alkhouli M, Van Houten HK, Yao X, Holmes DR. Effectiveness of transcatheter closure of patent foramen ovale in clinical practice. J Am Heart Assoc. 2023;12:e030321.
104. Alsheikh-Ali AA, Thaler DE, Kent DM. Patent foramen ovale in cryptogenic stroke: incidental or pathogenic? Stroke. 2009;40:2349-55.
105. Homma S, DiTullio MR, Sacco RL, Sciacca RR, Mohr JP; PICSS Investigators. Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen ovale. Stroke. 2004;35:2145-9.
106. Mazzucco S, Li L, Rothwell PM. Prognosis of cryptogenic stroke with patent foramen ovale at older ages and implications for trials: a population-based study and systematic review. JAMA Neurol. 2020;77:1279-87.
107. Vukadinović D, Scheller B, Ukena C, Ewen S, Mahfoud F, Böhm M. Device-related risk of atrial fibrillation after closure of patent foramen ovale: a systematic review and meta-analysis. Clin Res Cardiol. 2022;111:583-7.
108. Apostolos A, Tsiachris D, Drakopoulou M, et al. Atrial fibrillation after patent foramen ovale closure: incidence, pathophysiology, and management. J Am Heart Assoc. 2024;13:e034249.
109. Poulin MF, Kavinsky CJ. Low burden of atrial fibrillation after PFO closure: is there a need to worry? J Soc Cardiovasc Angiogr Interv. 2024;3:102145.
110. Elgendy AY, Elgendy IY, Mojadidi MK, et al. New-onset atrial fibrillation following percutaneous patent foramen ovale closure: a systematic review and meta-analysis of randomised trials. EuroIntervention. 2019;14:1788-90.
111. Egidy Assenza G, Spinardi L, Mariucci E, et al. Transcatheter closure of PFO and ASD: multimodality imaging for patient selection and perioperative guidance. J Cardiovasc Dev Dis. 2021;8:78.
112. Apostolos A, Drakopoulou M, Trantalis G, et al. Management of patent foramen ovale; findings from a nationwide survey. J Stroke Cerebrovasc Dis. 2024;33:107551.
