PFO and cryptogenic stroke – identifying and treating the cause
If a PFO is detected in a stroke patient, strictly speaking, it should no longer be referred to as a cryptogenic stroke, as the PFO provides a plausible cause for the stroke: a paradoxical embolism (a blood clot that enters the brain through the PFO). We have proposed (and many international experts now agree with us) that such cases be referred to as ‘PFO-associated stroke’. Based on the results of numerous studies, British, European and US guidelines have adjusted their recommendations in recent years and now advocate PFO closure in selected stroke patients with no other cause.
Catheter closure of a PFO serves to prevent further strokes by permanently closing the ‘hole in the heart’. It is important to make the treatment as gentle as possible for the patient.
Outpatient, minimally invasive procedure without "TEE stress"
We perform PFO closure using a minimally invasive cardiac catheter. A thin catheter is inserted through the groin vein and advanced to the heart, where the PFO is closed – open heart surgery is not necessary. Local anesthesia and, if necessary, a mild sedative are usually sufficient; general anesthesia is not necessary. Thanks to a method we have developed, in most cases we do not need to use transesophageal echocardiography (TEE) during the procedure. The procedure is primarily performed under X-ray fluoroscopy and, if necessary, with contrast medium, so that guidance by means of transesophageal ultrasound is not required. For our patients, this means greater comfort, as the TEE examination, which is often perceived as unpleasant, is no longer necessary.
The procedure itself usually takes less than half an hour. We then observe the patient for a few hours. As a rule, the patient can be discharged on the same day – PFO closure is therefore an outpatient procedure.
Innovative closure techniques: "umbrella", suture and resorbable occluder
We have a range of modern techniques and implants available for PFO closure, which we use depending on the individual anatomical conditions. Our experts are among the most experienced in the world in this field and have played a key role in developing these procedures. We mainly use the following methods:
- Classic umbrella occluder:
A double-umbrella implant made of a fine Nitinol mesh is inserted into the hole via the catheter. It unfolds on both sides of the atrial septum, immediately closing the PFO. This proven procedure has been used worldwide for decades and has a high success rate. The tissue grows over the small ‘umbrella’ over the course of several weeks, creating a permanent closure. This implant remains in the heart, which is usually well tolerated; however, foreign material remains permanently in the body. - Catheter suture closure (NobleStitch):
This is a procedure in which no metal implant remains in the heart. Instead, the foramen ovale is closed with a surgical suture using a special catheter. Two fine threads are precisely placed through the two parts of the septum (atrial septum) and then knotted together to tie off the PFO. Advantages: No foreign body remains, which avoids possible complications from implants (such as cardiac arrhythmias or nickel allergies). In addition, the atrial septum is not ‘blocked’ by a small umbrella, which facilitates later interventions in the heart (e.g. ablations or left heart catheterisation via the septum). Another advantage is that this suture closure usually does not require real-time echocardiographic monitoring – in uncomplicated cases, no TEE or intracardiac echo is necessaryrevportcardiol.org. The procedure is performed under X-ray guidance with contrast medium and, if necessary, an ultrasound Doppler test. Our specialists have extensive experience with this NobleStitch system and can therefore offer a very gentle closure in suitable cases. - Fully resorbable occluder (MemoSorb®):
This involves the use of a new type of ‘umbrella’ closure, which functions similarly to the classic double umbrella but is made of fully degradable material. The implant dissolves on its own after a few months, once the PFO has been closed by the patient's own tissue – no material remains in the body in the long term. MemoSorb® is the world's first bioresorbable PFO occluder. Prof. Sievert performed the first procedure in Europe with this occluder in 2024. MemoSorb has already been used successfully in over 3,000 patients in China, with excellent results. The MemoSorb occluder is not yet officially approved in Europe (CE marking pending). However, it has already been approved by the Chinese authorities (NMPA 2023) and can be used if necessary under an individual exemption. We are happy to consider this option for suitable patients.
Decades of experience of our specialists
Our patients benefit from the outstanding experience of our team. Prof. Dr. Horst Sievert is one of the world's leading cardiologists in the field of interventional cardiology. He has been performing PFO closures for decades and was involved in the first catheter-based closures worldwide. With over 80,000 cardiac catheter procedures performed, Prof. Sievert is one of the most experienced interventional cardiologists in the world. He is considered a pioneer in PFO and atrial septal closure as well as new techniques such as the suture closure method and the use of resorbable occluders. This combined expertise benefits each and every patient. You can be confident that you are being treated by world-class experts who perform PFO closure with the utmost safety and expertise.
Conclusion: Through catheter-based PFO closure – on an outpatient basis, without unnecessary stress and using state-of-the-art procedures – we can effectively protect patients with PFO-associated stroke from further attacks. We rely on individually tailored therapy concepts and the many years of experience of our specialists to ensure that you receive the best possible, gentle treatment.