AMPLATZER PFO Occluder Post Approval Study

A maximum of 1214 adult subjects will be enrolled at up to 100 centers in the U.S. and
Canada. Subjects will have follow-up at 1 month, 6 months, 12 months and annually thereafter
through 5 years post implant.

Inclusion Criteria:

• Subjects with a PFO who have had an ischemic stroke within the last 270 days

Exclusion Criteria:

- Atherosclerosis or other arteriopathy of the intracranial and extracranial vessels
associated with a > 50% lumen diameter supplying the involved lesion

- Intra-cardiac thrombus or tumor

- Documented evidence of venous thrombus in the vessels through which access to the PFO
is gained

- Acute or recent (within 6 months prior to consent) myocardial infarction or unstable
angina

- Left ventricular aneurysm or akinesis

- Mitral valve stenosis or severe mitral regurgitation requiring intervention
irrespective of etiology

- Aortic valve stenosis (mean gradient >40 mmHg) or severe aortic valve regurgitation

- Mitral or aortic valve vegetation or prosthesis

- Aortic arch plaques protruding greater than 4mm into the aortic lumen

- Left ventricular dilated cardiomyopathy with depressed left ventricular ejection
fraction (LVEF less than 35%)

- Subjects with other source of right to left shunts, including an atrial septal defect
and/or fenestrated septum

- Chronic, persistent, or paroxysmal atrial fibrillation or atrial flutter

- Pregnancy at the time of implant

- Age less than 18 years or greater than 60 years at time of consent

- Active endocarditis or other untreated infections

- Organ failure (kidney, liver or lung) Kidney failure: Poor urine output of less than 1
cc/kg/hr with elevated BUN levels (above the normal reference range for the laboratory
at the investigational site).

Liver failure: Liver enzymes outside the normal reference range for the laboratory at the
investigational site: poor liver function as assessed by elevated PT (above the normal
reference range for the laboratory at the investigational site) and low total protein and
albumin (below the normal reference range for the laboratory at the investigational site).

Lung failure: Respiratory failure is retention of carbon dioxide more than 60 mmHg, poor
oxygenation with oxygen tension less than 40 mmHg in room air or the need for assisted
ventilation.

- Uncontrolled hypertension defined as sustained elevated systemic blood pressure to
more than 160/90 mmHg with medications

- Uncontrolled diabetes defined as continued elevated glucose levels in spite of
administration of insulin/levels of more than 200 mg with presence of glucose in the
urine

- Diagnosis of lacunar infarct probably due to intrinsic small vessel as qualifying
stroke event Definition: Ischemic stroke in the distribution of a single, small deep
penetrating vessel in a patient with any of the following: 1) a history of
hypertension (except in the first week post stroke); 2) history of diabetes mellitus;
3) Age >/= 50; or 4) MRI or CT shows leukoaraiosis greater than symmetric,
well-defined periventricular caps or bands (European Task Force on Age-Related White
Matter Changes rating scale score > 0)

- Arterial dissection as cause of stroke

- Subjects who test positive with one of the following hypercoagulable states;
Anticardiolipin Ab of the IgG or IgM, Lupus anticoagulant, B2-glycoprotein-1
antibodies or persistently elevated fasting plasma homocysteine despite medical
therapy

- Unable to take antiplatelet therapy

- Anatomy in which the AMPLATZERTM PFO Occluder device size required would interfere
with intracardiac or intravascular structures such as valves or pulmonary veins

- Vasculature, through which access to the PFO is gained, is inadequate to accommodate
the appropriate sheath size

- Malignancy or other illness where life expectancy is less than 2 years

- Subjects who will not be available for follow-up for the duration of the trial

- Inability to obtain Informed Consent from patient

- Index stroke of poor outcome (modified Rankin score greater than 3)