IJCS | Volume 33, Nº4, July and August 2020

315 1. Feldman DN, Weinberger J, Elmariah S. Device Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke: The Tide Has Turned*. J Am Coll Cardiol. 2018;71(20):2343-5. 2. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, et al. Long-TermOutcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med. 2017;377(11):1022-32. 3. Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, et al. Closure or Medical Therapy for Cryptogenic Stroke with Patent Foramen Ovale. N Engl J Med. 2012;366(11):991-9. 4. Mojadidi MK, ZamanMO, Elgendy IY, MahmoudAN, Patel NK,Agarwal N, et al. Cryptogenic Stroke and Patent ForamenOvale. JAmColl Cardiol. 2018;71(9):1035-43. 5. Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al. Percutaneous Closure of Patent Foramen Ovale in Cryptogenic Embolism. N Engl J Med. 2013;368(12):1083-91. 6. Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen- Kudsk JE, et al. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med. 2017;377(11):1033-42. 7. Farb A, Ibrahim NG, Zuckerman BD. Patent Foramen Ovale after Cryptogenic Stroke - Assessing the Evidence for Closure. N Engl J Med. 2017;377(11):1006-9. 8. Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al. Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke. N Engl J Med. 2013;368(12):1092-100. 9. Mas J-L, DerumeauxG, Guillon B, Massardier E, Hosseini H, Mechtouff L, et al. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med. 2017;377(11):1011-21. 10. Lee PH, Song J-K, Kim JS, Heo R, Lee S, Kim D-H, et al. Cryptogenic Stroke and High-Risk Patent Foramen Ovale. The DEFENSE-PFO Trial. J Am Coll Cardiol. 2018;71(20):2335-42. 11. Ropper AH. Tipping Point for Patent Foramen Ovale Closure. N Engl J Med. 2017;377(11):1093-5. 12. Vidale S, Russo F, Campana C, Agostoni E. Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized Trials. Angiology.2019;70(4):325-31. 13. Lai J, Tse G, WuW, Gong M, Bazoukis G, Wong W, et al. Patent foramen ovale closure versus medical therapy for stroke prevention:A systematic review and meta-analysis of randomized controlled trials [Version 2; referees: 2 approved]. F1000Research. 2018;6(2178). 14. Sitwala P, Khalid MF, Khattak F, Bagai J, Bhogal S, Ladia V, et al. Percutaneous closure of patent foramen ovale in patients with References Pereira et al. Patent foramen ovale in cryptogenic stroke Int J Cardiovasc Sci. 2020; 33(4):307-317 Original Article If residual shunts persisted, this might mask the real efficacy of PFO closure in the prevention of recurrent strokes. Similarly, some patients of medical group underwent PFO closure with devices approved by the Food and Drug Administration (FDA) for other indications (off-label use). In the medical therapy groups, there was lack of standardization in the type and doses of the medical therapy used in each site and the use of anticoagulant treatment was more frequent as compared with the closure group. In addition, discontinuation of antithrombotic treatment was allowed after PFO closure in many trials, which may have increased the risk of non-PFO-related stroke in these studies. Finally, the definitions used for reporting atrial fibrillation varied among trials and may not be directly comparable. Conclusions At the present stage, patent foramen ovale closure seems to be superior to medical treatment in reducing recurrent stroke in patients with cryptogenic stroke. Comparable risks of TIA for both strategies have been seen in the studies published so far. Furthermore, even though a significantly higher risk of new-onset atrial fibrillation was seen with closure, studies suggested that it was usually periprocedural. These findings suggest that PFO closure is a better strategy for secondary prevention of recurrent stroke in patients with a cryptogenic stroke and patent foramen ovale. Author contributions Conception and design of the research: all authors. Acquisitionof data: SPPP,AN.Analysis and interpretation of the data: all authors. Statistical analysis: JPLN, CS. Writing of the manuscript: all authors. Critical revision of the manuscript for intellectual content: all authors Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is associated with the master thesis of the first author. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors.