PFO closure options in US/offshore

I had a stroke about a week ago and was told that I have a PFO. I'm still in the process of talking to various docs about what to do about it. From what I read, I really want to get it closed. I didn't get information about the size and other complications of the PFO because I didn't know they were relevant, but I'm going to get those from my cardio doc next week.

What is interesting is that percutaneous PFO closure seems to be very standard and routine in places like UK, Europe, Australia, etc. However, in the US it seems to be mired up in clinical trials. For instance with my health plan, Kaiser, I would have to get into a clinical trial to do the closure, at least for the percutaneous method of it. I'm not sure yet about other methods.

Has anybody gone offshore to do this? I filled out a form on a medical tourism site and now they're bugging me to have a consultation with a doctor in India. They look like they're competent.

I'm not saying I'm ready to jump into doing this offshore. It just seems odd that the surgery is available in so many places except the US. I wouldn't be adverse to paying for the the procedure in the US if my provider didn't cover it, but it seems difficult to get it done outside of a study in the US. Am I wrong?

Where are you located? I thought the same things, before I did more research. Check out my story: http://grappling-with-life.blogspot.com/

Thanks. It's been a bit of a learning process for me. It turns out that my HMO will do the surgery, but the surgeon is bugging me to get into a randomized trial instead of getting the surgery outright. When I sit down and think about it, I really can't tell you why, other than he doesn't believe the data for closure is there yet.

They want "randomized" trials. There's no such thing as random. The only true randomizer is God. For instance the sample pool for PFO closure trials are biased by at least 2 things:

1. More pathogenic PFOs are going to be closed outside of the trials. This will bias the data against PFO closure benefits.

2. The trials will do the procedure and the medical treatments for free. That means you're going to be selecting for people without insurance, which very likely increases the frequency of behavioral issues that contribute to strokes like drug users, smokers, etc. This will tend to increase the stroke risk on both sides, so instead of 1% versus 3%, a 300% benefit, you go to 5% versus 7%, only a 30% benefit.

Just a guess. I'm leaning towards the closure surgery.