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Patent foramen ovale (PFO), a hole between the left and right atria of the heart, is known to be a cause of stroke in young adults.

Randomised trials have shown that percutaneous closure of PFO is highly effective in preventing recurrent strokes in patients aged ≤60 years. However, it is uncertain whether PFO is a common cause of stroke in older patients and whether trials of PFO-closure at older ages would be feasible.

PFO-screening in over 1000 Oxford Vascular Study patients using transcranial Doppler (TCD) bubble detection was completed in 2018. Bubble-TCD was feasible in older patients with TIA/non-disabling stroke, and there was a strong association between PFO and TIA/stroke of otherwise unknown cause at older ages. These results indicate that randomised trials of PFO-closure are now required at older ages and show that bubble-TCD is a feasible approach to identifying potential recruits. The work also demonstrated the substantial burden of PFO-related stroke at the population-level.

Mazzucco S, Li L, Binney L, Rothwell PM; Oxford Vascular Study Phenotyped Cohort. Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages. Lancet Neurol 2018;17:609-617.

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