Pathophysiological Insights and Clinical Implications of Patent Foramen Ovale-Related Stroke: A Comprehensive Review

Elmukhtar Habas¹, Ala Habas², Khaled Alarbi³, Eshrak Habas⁴, Mohamed Baghi⁵, Aml Habas⁶, Almehdi Errayes⁷, Abdulraman Hamad⁸, Ebtihal Abdelmoneim Hassan⁹, Amnna Rayani¹⁰

Keywords: Patent foramen ovale, cryptogenic stroke, paradoxical embolism, right-to-left shunt, PFO closure, stroke prevention

DOI: 10.63475/yjm.v4i2.0190

DOI URL: https://doi.org/10.63475/yjm.v4i2.0190

Publish Date: 22-09-2025

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Pages: 284 - 300

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Author Affiliation:

1 Professor/Senior Consultant, Department of Medicine, Hamad General Hospital, HMC, Open Libyan University, Qatar University, Doha, Qatar
2 Resident, Department of Medicine, Tripoli Central Hospital, Tripoli, Libya
3 Associate Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
4 Associate Consultant, Department of Medicine, Tripoli Central Hospital, Tripoli University, Tripoli, Libya
5 Associate Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
6 Specialist, Hematology Department, Tripoli Pediatric Hospital, Tripoli, Libya
7 Senior Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
8 Senior Consultant, Department of Medicine, Hamad General Hospital, Doha, Qatar
9 Consultant, Department of Accident and Emergency, Hamad General Hospital, Doha, Qatar
10 Professor, Hematology Department, Tripoli Pediatric Hospital, University of Tripoli, Tripoli, Libya

Abstract

Patent foramen ovale (PFO) is a prevalent congenital cardiac anomaly. It is increasingly acknowledged as a significant factor in cryptogenic ischemic stroke, especially among young adults experiencing otherwise unexplained cerebrovascular incidents. This review summarizes recent advances in the epidemiology, pathophysiology, diagnostic strategies, and management of PFO-related stroke. The article examines the intricate mechanisms of PFO-associated strokes, including paradoxical embolism, in situ thrombus formation, and atrial cardiopathy, while emphasizing the significance of anatomical risk factors like large shunt size and atrial septal aneurysm. The clinical implications of PFO in various disorders, such as migraine with aura, decompression sickness, and high-altitude pulmonary edema, are also analyzed. Diagnostic modalities such as echocardiography and transcranial Doppler are compared, focusing on their sensitivities and procedural details. The review focuses on evidence-based methods for medical, interventional, and device-based closure of PFO, highlighting patient selection and ongoing controversies. The ongoing uncertainties surrounding causal relationships, risk stratification, and optimal therapy highlight the necessity for continued research. This review offers a current synthesis for clinicians and researchers addressing the challenges associated with the evaluation and management of PFO in stroke prevention. To achieve the aims of the article and make it concise, PubMed, Google, EMBASE, Google Scholar, and Scopus were searched for original and review articles published in the last 10 years. Several keywords, phrases, and texts were utilized.

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