PFO Evaluation

One risk of stroke can be a clot that travels from the veins of the legs to the arteries of the brain. This can occur in people who have a persistent conduit between the two, a hole in the heart; also known as a patent foramen ovale (PFO). Everyone has a PFO at some point of development but 2/3 of them close on their own. In the other 1/3, the hole in the heart will remain open. Several studies have been done to see if closing that conduit is beneficial in reducing the risk of stroke. A few of these studies include CLOSURE 1, PC Trial, and RESPECT. The findings suggest that closure of the PFO may not bring a significant reduction in stroke risk unless the patient meets certain criteria. These criteria include recurrent strokes in the presence of a large PFO without other sources determined.

Providers at Nevada Neurology and Vascular Center were involved in the original PFO closure studies. Although the findings suggest that PFO closure should not be done on a regular basis, there are some exceptions. The studies did not take into account for patients with clotting disorders (hypercoagulability).

In addition, the studies did not take into account the size of the hole. The PFO was often identified by an echocardiogram. Unfortunately, echocardiograms are only able to detect the holes in 50% of people who have them. As a result, when the echocardiograms identify a person with a PFO, the test was not able to determine the size that could have a large impact on the risk of a clot being able to traverse the hole.

Transcranial Doppler (TCD) PFO evaluation has become the standard in not only detecting a PFO (Able to detect 99% of those patients with PFOs) but also reliably able to identify the size of the hole.

The FDA has determined that a person can qualify for PFO closures under special circumstances. One of the circumstances is having recurrent strokes after the identification of a person as having a PFO that could contribute to the stroke. Come to our center to find out if you have a PFO. And if you do, we can determine it’s size and your risk of having a stroke. Therefore, if a stroke occurs then you may not have to wait for another stroke to happen in order to get the problem fixed.