Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke

Jonathan M. Tobis (Lead / Corresponding author), Akram Y. Elgendy, Jeffrey L. Saver, Zahid Amin, Konstantinos Dean Boudoulas, John D. Carroll, Islam Y. Elgendy, Iris Q. Grunwald, Zachary M. Gertz, Ziyad M. Hijazi, Eric M. Horlick, Scott E. Kasner, David M. Kent, Preetham Kumar, Clifford J. Kavinsky, David S. Liebeskind, Helmi Lutsep, Mohammad K. Mojadidi, Steven R. Messé, Jean Louis MasHeinrich P. Mattle, Bernhard Meier, Ahmad Mahmoud, Ahmed N. Mahmoud, Fabian Nietlispach, Nimesh K. Patel, John F. Rhodes, Mark Reisman, Robert J. Sommer, Horst Sievert, Lars Søndergaard, Muhammad O. Zaman, David Thaler

Research output: Contribution to journalArticlepeer-review

88 Citations (Scopus)


Importance: Recent epidemiologic and therapeutic advances have transformed understanding of the role of and therapeutic approach to patent foramen ovale (PFO) in ischemic stroke. Patent foramen ovale is likely responsible for approximately 5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults.

Observations: Randomized clinical trials have demonstrated that, to prevent recurrent ischemic stroke in patients with PFO and an otherwise-cryptogenic index ischemic stroke, PFO closure is superior to antiplatelet medical therapy alone; these trials have provided some evidence that, among medical therapy options, anticoagulants may be more effective than antiplatelet agents.

Conclusions and Relevance: These new data indicate a need to update classification schemes of causative mechanisms in stroke, developed in an era in which an association between PFO and stroke was viewed as uncertain. We propose a revised general nomenclature and classification framework for PFO-associated stroke and detailed revisions for the 3 major stroke subtyping algorithms in wide use.

Original languageEnglish
Pages (from-to)878-886
Number of pages9
JournalJAMA Neurology
Issue number7
Early online date13 Apr 2020
Publication statusPublished - 1 Jul 2020

ASJC Scopus subject areas

  • Clinical Neurology


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