In patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of PFO with right-to-left shunt. The timing of the stroke in migraineurs is usually not related to a migraine attack. These observations are consistent with the hypothesis that the mechanism of stroke in migraineurs is most likely because of a paradoxical embolus. Future cryptogenic stroke classification schemes should consider including PFO as a separate etiologic category.

Over 50% of people who rapidly ascend to extreme altitudes develop various symptoms known as acute mountain sickness (AMS), which rarely can be life threatening. It is unclear why some people are more susceptible to AMS than others. Our objective was to determine whether patent foramen ovale (PFO) is a risk factor for AMS. Subjects who had hiked to altitudes above 10,000' (~3,000 meters) on the John Muir Trail in California were recruited. Participants completed a questionnaire and two-physician adjudication was performed in regard to AMS status. A transcranial Doppler with agitated saline contrast injection was performed to evaluate the presence or absence of PFO. The primary outcome was the development of AMS. From 2016 to 2018, 137 hikers were recruited into the study. There was a higher prevalence of PFO in hikers with AMS 15/24 (63%) compared to hikers without AMS 44/113 (39%); p = 0.034. In the multivariate model, the presence of a PFO significantly increased the risk for developing AMS: OR 4.15, 95% CI 1.14-15.05; p = 0.030. In conclusion, hikers with a PFO had significantly higher risk of developing AMS relative to hikers without a PFO. Clinicians should consider PFO a risk factor in people who plan to hike to high altitudes.

Objectives To compare residual shunt rate and complications associated with six different devices used for PFO closure. Background Transcutaneous PFO closure is an effective treatment for preventing recurrent stroke in patients with a history of cryptogenic stroke. The rate of residual shunt is one metric by which the technical success of PFO closure can be measured. Methods Patients who underwent PFO closure at a single center between February 2001 and July 2019 were retrospectively enrolled in the study. Right‐to‐left shunt at baseline and during follow‐up was assessed using transcranial Doppler (TCD) or transthoracic echocardiography (TTE). Periprocedural and device‐related complications, including atrial fibrillation, were also assessed. Results Of 467 PFO closures performed during this period, 320 patients received quantitative assessment of right‐to‐left shunting both before and after percutaneous closure. The highest effective closure was achieved with the Cardioform device (100%, n = 104), followed by the Amplatzer Cribriform (93%, n = 14), Helex (90%, n = 137), Amplatzer ASO (88%, n = 17), CardioSEAL (86%, n = 14), and Amplatzer PFO (85%, n = 33) devices. The most common significant adverse event was atrial fibrillation, which was more common with the Cardioform device (13%) than the Helex (4%) or the Amplatzer PFO (4%) devices. Conclusions The Gore Cardioform Septal Occluder provides more robust closure of a PFO when compared to other devices but its effectiveness is offset by the higher prevalence of transient atrial fibrillation.

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