J Stroke Cerebrovasc Dis. 2026 Jan 15:108562. doi: 10.1016/j.jstrokecerebrovasdis.2026.108562. Online ahead of print.
ABSTRACT
BACKGROUND: There is lacking of robust clinical evidence comparing transcatheter closure with antithrombotic therapy in elderly patent foramen ovale (PFO) patients with cryptogenic stroke.
METHODS: The Pubmed, Embase, Web of Science, clinicaltrials.gov and Cochrane Library databases were systematically searched. Studies comparing transcatheter closure therapy with antithrombotic drug therapy in PFO patients in older age (≥55 years old) were included. The number of patients with and without events in both experimental group and control group were extracted. There were three study endpoints: composite endpoint of recurrent ischemic stroke and transient ischemic attack (TIA); all-cause death; new-onset atrial fibrillation. A random-effect model was performed. Heterogeneity among selected publications was assessed using Q-test based on a χ² test. I2>50% was defined as high heterogeneity. P < 0.05 was considered statistically significant.
RESULTS: Nine studies of 7275 elderly PFO patients with cryptogenic stroke were included. Patients undergoing PFO closure had significantly lower risk of a composite endpoint of recurrent stroke and TIA (4.74% versus 8.08%, OR=0.517, 95% CI:0.325-0.821) and all-cause death (1.17% versus 1.24%, OR=0.531, 95% CI: 0.317-0.891). There was no significant different occurrence of new-onset atrial fibrillation between the two groups (3.81% versus 2.82%, OR=1.218, 95% CI: 0.826-1.798). None of the studies measuring the three endpoints manifested high heterogeneity.
CONCLUSIONS: PFO closure might reduce the risk of composite endpoint of recurrent stroke and TIA and all-cause death, while not increase the risk of new-onset atrial fibrillation comparing with medication therapy in elderly PFO patients with cryptogenic stroke. PFO closure should be considered part of a comprehensive secondary prevention strategy in elderly patients.
PMID:41547485 | DOI:10.1016/j.jstrokecerebrovasdis.2026.108562