Patent Foramen Ovale Closure in Stroke and the PASCAL Classification System

Among young and middle-aged individuals (ages 18-60 years) with patent foramen ovale (PFO) and otherwise cryptogenic ischemic stroke enrolled in pivotal trials, can the PASCAL classification system identify those who will experience net benefit and those who will experience net harm from PFO closure in the next 5 years?This meta-analysis showed that in the PASCAL groups probable and possible, PFO closure reduced recurrent ischemic stroke more often than it caused atrial fibrillation, but in the unlikely group, closure did not reduce stroke and caused a larger amount of atrial fibrillation.The PASCAL classification system may identify as many as 4 of 5 patients who will experience net benefit and 1 of 5 who will experience net harm from PFO closure.

Corresponding Authors: Jeffrey L. Saver, MD, Reed Neurologic Research Center, University of California, Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095 (jsaver@mednet.ucla.edu); David M. Kent, MD, MS, Tufts Medical Center, 800 Washington St, Box 63, Boston, MA 02111 (david.kent@tuftsmedicine.org).

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