Adults aged 60 years or less with a history of ischaemic stroke / transient ischaemic attack due to a paradoxical embolism, supported with evidence from brain imaging abnormalities (modified Rankin scale of 3 or less). Thorough investigations to exclude other risk factors for stroke (atrial fibrillation, hypertension or vascular disease, including arterial dissection). Large-sized interatrial shunt and a septal aneurysm are high-risk features for paradoxical embolism. Multidisciplinary team discussion: stroke physician and interventional cardiologist must confirm that paradoxical embolism is the most likely cause of the stroke. The patent foramen ovale closure must be performed by an experienced interventional cardiologist after gaining consent. The centres performing patent foramen ovale closure must have a cardiac surgical back up.
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