Beyond Anticoagulation: Understanding Medical Therapy Failure in PFO-Related Stroke and the Case for Closure

This narrative review examines why anticoagulation fails in some patients with patent foramen ovale (PFO)-related cryptogenic stroke, synthesizing evidence showing transcatheter closure is superior to medical therapy in appropriately selected patients. The analysis incorporates pathophysiological mechanisms, randomized trial comparisons, and risk stratification tools (RoPE score, PASCAL classification) to guide optimal therapeutic selection.