Medicine Grand Rounds, Joseph Rossi and William Powers, “PFO Closure to Reduce Stroke Risk — How Compelling Is the Evidence?”

Recent clinical trials have investigated the efficacy of mechanical closure of patent foramen ovale (PFO) for prevention of recurrent stroke. We will review the epidemiological evidence linking PFO and stroke, the methodology and results of clinical trials of secondary stroke prevention in patients with PFO, and the techniques for mechanical closure of PFO.

William J. Powers, MD, is an expert on cerebral blood flow and metabolism, as well as stroke treatment and prevention. Powers has dedicated his career to improving the outcome of patients with stroke and cerebrovascular disease. His early work helped establish concepts of blood pressure auto-regulation and acute blood pressure management in stroke, influential on the choice and timing of anti-hypertensive therapies and the consideration of acute vs. chronic blood pressure control. He later identified patterns of blood pressure control in intracerebral hemorrhage and noted that the tissue surrounding the hemorrhage is not ischemic. Powers spearheaded studies suggesting chronic hemodynamic impairment from occlusive cerebrovascular disease. He is the H. Houston Merritt Distinguished Professor and chair of the Department of Neurology.

Joseph Rossi, MD, MSCI, FACC, FSCAI, is director of the Cardiac Catheterization Lab and Program Director of the Interventional Cardiology Fellowship. He specializes in interventional cardiology.