Medical Treatment With or Without Transcatheter Patent Foramen Ovale Closure

Inclusion Criteria: * Cryptogenic stroke * Age \>60 years * Right-to-left shunt as evaluated by echocardiography (TEE). Exclusion Criteria: -≤60 year-old * Lacunar (small vessel) stroke. * Permanent or paroxysmal atrial fibrillation/flutter (clinically apparent or detected by continuous ECG monitoring). * Need for chronic anticoagulation therapy. * Any contraindication for antiplatelet therapy (aspirin, clopidogrel, ticagrelor). * Presence of extracranial or intracranial atherosclerosis causing ≥50% luminal --stenosis in arteries supplying the area of ischemia. * Presence of complex atheroma plaques at the ascending aorta-aortic arch (≥4-mm-thick, ulcerated or containing mobile thrombi) as evaluated by TEE. * Presence of intracardiac thrombus as evaluated by TEE. * Uncontrolled hypertension (systemic pressure values \>160/90 mmHg despite optimal medical treatment). * History of myocardial infarction or coronary intervention. (percutaneous coronary intervention, coronary artery bypass graft). * History of prior valve surgery or transcatheter valve repair. * Presence of deep venous thrombosis at the time of index stroke as evaluated by Doppler ultrasonography. * Left ventricular ejection fraction \<50% as evaluated by TTE. * Significant (moderate or severe) valvular disease as evaluated by echocardiography. * History of congestive heart failure. * Severe chronic kidney dysfunction defined an estimated glomerular filtration rate \<30 ml/min/m2 or need for dialysis. * Isolated ASD or ASD associated with PFO but with a hemodynamically significant left-to-right shunt requiring closure. * Other specific cause of stroke identified (eg, arteritis, dissection, migraine/vasospasm, and drug abuse). * Prior surgical or endovascular treatments of PFO or ASD. * Rheumatic heart disease. * Left atrial enlargement defined as a left atrial diameter \>41 mm in men and ≥39 mm in women. * Presence of high burden of premature atrial contractions (\>500 per 24 hrs) as evaluated by continuous ECG monitoring. * Follow-up impossible or expected poor compliance. * Active cancer. * Presence of an inferior vena cava filter. * Severe pulmonary artery hypertension (systolic pulmonary pressure \>60 mmHg). * Functional dependency as measured by a modified Rankin Scale score \>3 (unable to attend to own bodily needs without assistance and unable to walk unassisted). * Any medical condition determining a life expectancy \<2 years. * Participation in another randomized study. * Failure to provide signed informed consent.