Challenges in Cryptogenic Stroke: Identifying Candidates for Patent Foramen Ovale Closure

1.00 CME
1.00 CME with ABIM MOC
$0 FEE
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Faculty headshots for crytogenic stroke activity


Provider Statement

This continuing medical education activity is provided by Vindico Medical Education

Support Statement

This activity is supported by an educational grant from W.L. Gore & Associates, Inc.

Activity Description

Cryptogenic stroke refers to ischemic brain infarct of undetermined etiology despite extensive clinical evaluation. With recent epidemiologic data and diagnostic advancements, classification terminology has evolved to include the concept of embolic stroke of undetermined source (ESUS), which accounts for about 20% of all ischemic stroke. Approximately 40% of patients who experience cryptogenic stroke or ESUS are found to have an atrial septal defect called patent foramen ovale (PFO), which is associated with an increased risk of recurrent stroke. Randomized clinical trial data now support the safety and efficacy of transcatheter PFO closure for secondary stroke prevention. After a period of considerable debate regarding safety and efficacy, updated clinical practice guidelines now recommend PFO closure for appropriately selected patients following evaluation by neurology and cardiology, along with discussion of the procedural risks and benefits. In this expert panel activity, faculty describe diagnostic and classification criteria, explain the link between PFO and embolic stroke, and review strategies for prevention of recurrent stroke in patients with PFO. Faculty also review the latest data on the safety and efficacy of PFO closure and discuss guidelines for applying this data to clinical practice.

Target Audience

The intended audience for this activity is cardiologists, internists, neurologists, and other health care professionals involved in the management of patients with cryptogenic stroke.

Learning Objectives

Upon successful completion of this educational activity, participants should be better able to:

  • Review the prevalence of cryptogenic stroke and current evidence regarding its etiology.
  • Incorporate appropriate diagnostic and classification criteria into practice to expedite diagnosis and treatment of cryptogenic stroke.
  • Examine current treatment options for cryptogenic stroke, in terms of their efficacy, benefits, and limitations.
  • Recognize the association between patent foramen ovale (PFO) and cryptogenic stroke to better understand treatment that may improve outcomes.
  • Apply new guidelines and evidence into practice regarding the use of PFO closure in reducing the risk of recurrent stroke.

Activity Chair

Howard C. Herrmann, MD, FACC, MSCAI
John W. Bryfogle Professor of Medicine
Perelman School of Medicine of the University of Pennsylvania
Health System Director, Interventional Cardiology
Director, Cardiac Catheterization Lab
Hospital of the University of Pennsylvania
Philadelphia, PA


John D. Carroll, MD, MSCAI, FACC
Professor of Medicine
Director of Interventional Cardiology
University of Colorado School of Medicine
Aurora, CO

Scott E. Kasner, MD, MSCE
Professor of Medicine
Chief, Division of Vascular Neurology
Vice Chair for Clinical Affairs
Department of Neurology
University of Pennsylvania
Philadelphia, PA


Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP


Vindico Medical Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation

Vindico Medical Education designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

abimSuccessful completion of this CME activity enables the participant to earn up to 1.0 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Participants who opt-in will earn MOC points equivalent to the amount of CME credits claimed for the activity.

This enduring material is approved for 1 year from the date of original release, April 30, 2021, to April 29, 2022.

How to Participate in This Activity and Obtain CME Credit

To participate in this CME activity, you must read the objectives, answer the polling and pretest questions, view the content, and complete the posttest and evaluation. Provide only one (1) correct answer for each question. A satisfactory score is defined as answering 3 of the 4 posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, Vindico Medical Education will issue an AMA PRA Category 1 Credit(s)™ certificate.


In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all accredited providers are required to mitigate and disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of accredited content. Individuals have a relevant financial relationship if they have a financial relationship in any amount occurring in the past 12 months with a commercial interest whose products or services are discussed in the accredited activity content over which the individual has control. Relationship information appears below.  

Activity Chair and Faculty report the following relationship(s)

Howard C. Herrmann, MD, FACC, MSCAI
Consulting Fee: Abbott Vascular, Edwards Lifesciences, Holistick Medical, Medtronic, Shockwave, Wells Fargo
Contracted Research: Abbott Vascular, Ancora, Boston Scientific, Edwards Lifesciences, Medtronic, Shockwave, Université Laval
Contracted Research (paid to institution): Medtronic, W.L. Gore
Ownership Interest: Holistick Medical, Microinterventional Devices
Editorial Fees: Massachusetts Medical Society

John D. Carroll, MD, MSCAI, FACC
Consulting Fee: Abbott Medical Optics, Holistick Medical

Scott E. Kasner, MD, MSCE
Royalty: UpToDate
Consulting Fee: Abbott Medical Optics, Bristol Myers Squibb, Medtronic
Contracted Research: W.L. Gore

Reviewer reports the following relationship(s)

Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP
No relevant financial relationships to disclose. 

Vindico Medical Education staff report the following relationship(s)

No relevant financial relationships to disclose.

Signed disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.

Unlabeled and Investigational Usage

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of US Food and Drug Administration (FDA)–approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non–FDA-approved or investigational use of products/devices.

Copyright Statement

Created and published by Vindico Medical Education, 6900 Grove Road, Building 100, Thorofare, NJ 08086-9447. Telephone: 856-994-9400; Fax: 856-384-6680. Printed in the USA. Copyright © 2021 Vindico Medical Education. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. The material presented at or in any of Vindico Medical Education continuing medical education activities does not necessarily reflect the views and opinions of Vindico Medical Education. Neither Vindico Medical Education nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the US Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

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