In this subset of patients transcatheter closure has a role as outlined above, but cases have been described in which surgical closure has not prevented stroke in patients with PFOs. Anticoagulation with warfarin is advisable for PFO cryptogenic stroke when there is a high prob¬ability that the PFO is indicated in paradoxical embo¬lism. Transcatheter device closure should be reserved for the management of PFOs and stroke caused by high-probability paradoxical emboli in individuals with thrombi demonstrated in veins of lower limbs or other veins that drain into the right atrium. If no clots are observed in these veins, PFO as the cause of cryptogenic stroke should be relegated to low probability.

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