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The results of data so far suggest that in patients with CS, PFO closure may be beneficial in reducing the risk of recurrent vascular events when compared with medical treatment. Furthermore, when using the Amplatzer device this can be performed with a very low-risk profile. The decision to proceed with PFO closure should be made on a case-by-case basis with the expertise of a multidisciplinary team and patient involvement. It is likely that in those with truly CS and a significant PFO device closure is appropriate; especially in those with high-risk anatomy.

In addition, closure for professional divers who have suffered an episode of PFO-attributable decompression illness, as well as amateur divers who are not willing to give up the sport and are able to accept the small risk of the procedure, is appropriate. As the data for migraine prevention is weaker it should be considered a last resort in those with severe refractory migraine.

In all these situations a combined decision should be made by expert physicians, mainly neurologists, and an experienced interventional cardiologist, alongside an open discussion with the patient. Further data is eagerly anticipated to increase clarity regarding those specific patients most likely to benefit from device closure.

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