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A patent foramen ovale (PFO) can be the cause of an ischemic stroke. However, whether or not a PFO is responsible varies according to the patient’s profile. Neurologists and cardiologists must carry out an etiological assessment, which should be even more thorough given that an obvious cause remains to be identified at this point. At the end of this assessment, the probability of a causal link between the ischemic stroke and PFO needs to be quantified. If this probability is high, a percutaneous PFO closure should be proposed. When there are several thromboembolic causes identified, the discussion is carried out on a case-by-case basis. The RoPE score and the PASCAL classification should be used when making a decision here. It is important to take into account echographic features when identifying the so-called high risk PFO. For patients over the age of sixty exposed to this risk, the rule must be to first look for silent atrial fibrillation before a possible percutaneous closure of the FOP.