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Review Article
Online Published: 29 Sep 2026
 


Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review

Abdullah K. Dakhel, Fahad A. Alqeaid, Moath M. Almutlaq, Sultan H. Alharbi, Mohammed K. Dakhel, Abdulelah M. Alrubayan, Abdulhadi A. Alharbi, Abdulrahman Alsaykhan, Saud W. Alqahtani, Abdulelah A. Alotaibi, Abdullah H. Alharbi.


Abstract
Cryptogenic stroke accounts for roughly one-third of all ischemic strokes, with patent foramen ovale (PFO) playing a significant role in many of these cases due to paradoxical embolism. Percutaneous PFO closure techniques have advanced significantly over the last decade, as randomized controlled trials showed lower recurrence rates in selected patients. However, as of 2025, there are ongoing debates over patient selection, particularly in older people, the comparative efficacy of anticoagulation, and long-term hazards like device-related atrial fibrillation. This review aimed to summarize the evidence from recent clinical trials, meta-analyses, and guidelines, focusing on advances in device technology, risk-stratification tools such as the Risk of Paradoxical Embolism (RoPE) score and the PFO-Associated Stroke Causal Likelihood (PASCAL) classification, and unresolved debates about procedural safety and generalizability. This review underlined the need for interdisciplinary neurocardiology teams and future research objectives in optimizing outcomes in this diverse group. Recent 2025 studies emphasized the necessity of long-term follow-up in determining closure efficacy, with meta-analyses indicating lasting benefits but highlighting heterogeneity in real-world implementations. Furthermore, new research on bioresorbable devices and AI-assisted diagnostics promises to solve present constraints in patient selection and procedural hazards.

Key words: Patent foramen ovale, cryptogenic stroke, PFO closure, paradoxical embolism, secondary prevention, randomized trials, review


 
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How to Cite this Article
Pubmed Style

Dakhel AK, Alqeaid FA, Almutlaq MM, Alharbi SH, Dakhel MK, Alrubayan AM, Alharbi AA, Alsaykhan A, Alqahtani SW, Alotaibi AA, Alharbi AH. Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. IJMDC. Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807

Web Style

Dakhel AK, Alqeaid FA, Almutlaq MM, Alharbi SH, Dakhel MK, Alrubayan AM, Alharbi AA, Alsaykhan A, Alqahtani SW, Alotaibi AA, Alharbi AH. Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. https://www.ijmdc.com/?mno=271312 [Access: September 29, 2026]. doi:10.24911/IJMDC.51-1752687807

AMA (American Medical Association) Style

Dakhel AK, Alqeaid FA, Almutlaq MM, Alharbi SH, Dakhel MK, Alrubayan AM, Alharbi AA, Alsaykhan A, Alqahtani SW, Alotaibi AA, Alharbi AH. Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. IJMDC. Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807


Vancouver/ICMJE Style

Dakhel AK, Alqeaid FA, Almutlaq MM, Alharbi SH, Dakhel MK, Alrubayan AM, Alharbi AA, Alsaykhan A, Alqahtani SW, Alotaibi AA, Alharbi AH. Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. IJMDC, [cited September 29, 2026]; Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807


Harvard Style

Dakhel, A. K., Alqeaid, . F. A., Almutlaq, . M. M., Alharbi, . S. H., Dakhel, . M. K., Alrubayan, . A. M., Alharbi, . A. A., Alsaykhan, . A., Alqahtani, . S. W., Alotaibi, . A. A. & Alharbi, . A. H. (2026) Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. IJMDC, Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807


Turabian Style

Dakhel, Abdullah K., Fahad A. Alqeaid, Moath M. Almutlaq, Sultan H. Alharbi, Mohammed K. Dakhel, Abdulelah M. Alrubayan, Abdulhadi A. Alharbi, Abdulrahman Alsaykhan, Saud W. Alqahtani, Abdulelah A. Alotaibi, and Abdullah H. Alharbi. 2026. Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. International Journal of Medicine in Developing Countries, Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807


Chicago Style

Dakhel, Abdullah K., Fahad A. Alqeaid, Moath M. Almutlaq, Sultan H. Alharbi, Mohammed K. Dakhel, Abdulelah M. Alrubayan, Abdulhadi A. Alharbi, Abdulrahman Alsaykhan, Saud W. Alqahtani, Abdulelah A. Alotaibi, and Abdullah H. Alharbi. "Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review." International Journal of Medicine in Developing Countries Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807


MLA (The Modern Language Association) Style

Dakhel, Abdullah K., Fahad A. Alqeaid, Moath M. Almutlaq, Sultan H. Alharbi, Mohammed K. Dakhel, Abdulelah M. Alrubayan, Abdulhadi A. Alharbi, Abdulrahman Alsaykhan, Saud W. Alqahtani, Abdulelah A. Alotaibi, and Abdullah H. Alharbi. "Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review." International Journal of Medicine in Developing Countries Online First: 29 Sep, 2026. Web. 29 Sep 2026 doi:10.24911/IJMDC.51-1752687807


APA (American Psychological Association) Style

Dakhel, A. K., Alqeaid, . F. A., Almutlaq, . M. M., Alharbi, . S. H., Dakhel, . M. K., Alrubayan, . A. M., Alharbi, . A. A., Alsaykhan, . A., Alqahtani, . S. W., Alotaibi, . A. A. & Alharbi, . A. H. (2026) Advances and ongoing controversies in patent foramen ovale closure and cryptogenic stroke: a 2025 review. International Journal of Medicine in Developing Countries, Online First: 29 Sep, 2026. doi:10.24911/IJMDC.51-1752687807




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