Carl Robertson: 12 Evidence-Based Recommendations for Stroke Prevention in PFO
Carl Robertson, Senior Territory Manager – Structural Intervention at Abbott, shared on LinkedIn about a recent article by Brian R. Chambers et al, published in Medical Journal of Australia, adding:
”Australia and New Zealand now have their first nationally endorsed consensus on PFO management for stroke prevention, marking a meaningful shift in how we approach the management of patients.
Published recently in the Medical Journal of Australia and endorsed by the Australasian Stroke Academy, the statement delivers 12 evidence-based recommendations across patient selection, diagnosis and treatment.
A few highlights that stand out:
- TCD bubble study is now the recommended first line screening tool, with 96.1% sensitivity, ahead of both TOE (89.2%) and TTE (45.1%). The key advantage: optimal Valsalva in an unsedated, upright patient.
- Universal PFO screening for all cryptogenic stroke patients aged ≤60. Not selected patients – all of them.
- The RoPE score alone is no longer sufficient. The PASCAL classification – which integrates high-risk anatomical features – should now guide closure decisions. In ‘Probable’ PASCAL patients, PFO closure achieved a hazard ratio of 0.10 for recurrent stroke.
- Every closure decision requires a multidisciplinary heart brain team – stroke neurologist and structural heart cardiologist together.
It’s great to see a wide clinician driven ecosystem working together to refine the standard of care.
Congratulations to all authors for advancing our field and strengthening the clinical pathways for the region.
Chambers BR et al. Medical Journal of Australia, 2026; 224:e70199”
Title: Diagnosis and Management of Patent Foramen Ovale for Stroke Prevention: An Australian and New Zealand Consensus Statement Developed by a Modified Nominal Group Approach
Authors: Brian R. Chambers, Lauren M. Sanders, Amanda Gilligan, Carlos Garcia-Esperon, Jan Ho, John Fink, Matias Yudi, Matthew Lee-Archer, Vimal Stanislaus, Andrew A. Wong
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