Patent foramen ovale (PFO) closure, along with medical therapy, has emerged as the therapeutic gold standard in younger (<60-year-old) patients with a PFO-related stroke for preventing recurrent events. However, PFO management guidelines lack definite recommendations for older (>60 years) patients with a PFO-related cerebrovascular event, a complex group of patients who were mostly excluded from PFO closure clinical trials. Nevertheless, several studies have shown a higher prevalence of PFO among older patients with cryptogenic stroke, and its presence has been associated with an increased risk of recurrent events. Furthermore, older patients exhibit a higher prevalence of high-risk PFO anatomical features, present inherent age-related risk factors that might increase the risk of paradoxical embolism through a PFO, and have a higher incidence of ischemic events after a PFO-related event. Additionally, observational studies have shown the safety and preliminary efficacy of PFO closure in older PFO-related stroke patients. Yet, higher rates of recurrent cerebrovascular events and new-onset atrial fibrillation were observed in some studies among older patients compared to their younger counterparts. After careful case-by-case evaluation, including the assessment of hidden potential cardioembolic sources of a cryptogenic stroke other than PFO, transcatheter PFO closure might be a safe and effective therapeutic option for preventing recurrent thromboembolic events in patients >60 years with a high-risk PFO-associated stroke. Ongoing trials will provide important insights into the role of PFO closure in the elderly population.

中文翻译：

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老年卵圆孔未闭患者的脑血管事件：现状和未来展望。

卵圆孔未闭 (PFO) 封堵术和药物治疗已成为年轻（<60 岁）PFO 相关中风患者预防复发事件的治疗金标准。然而，PFO 管理指南缺乏针对患有 PFO 相关脑血管事件的老年（> 60 岁）患者的明确建议，这是一组复杂的患者，他们大多被排除在 PFO 封堵临床试验之外。然而，一些研究表明，在患有隐源性中风的老年患者中，PFO 的患病率较高，并且其存在与复发事件的风险增加有关。此外，老年患者表现出高风险 PFO 解剖特征的患病率较高，存在固有的与年龄相关的危险因素，可能会增加 PFO 引起的矛盾栓塞的风险，并且 PFO 相关事件后缺血事件的发生率较高。此外，观察性研究表明 PFO 封堵术对于老年 PFO 相关中风患者的安全性和初步疗效。然而，一些研究发现，与年轻患者相比，老年患者的复发性脑血管事件和新发房颤的发生率更高。经过仔细的逐案评估，包括评估除 PFO 之外的隐源性中风的隐藏潜在心源性栓塞来源，经导管 PFO 封堵术可能是一种安全有效的治疗选择，可用于预防 60 岁以上患有高危因素的患者复发性血栓栓塞事件。 PFO 相关的中风风险。正在进行的试验将为了解 PFO 封堵术在老年人群中的作用提供重要见解。