Objective We sought to investigate the clinical characteristics and echocardiographic changes of cryptogenic perforator infarction（PI） patient with patent foramen ovale（PFO）. Methods From Jan 2015 to Dec 2023， patients diagnosed with cryptogenic stroke were retrospectively included in our study. All patients received transthoracic echocardiography（TTE） and transcranial Doppler（TCD）.PFO was diagnosed by the bubble test of TCD. Comparisons of clinical features and TTE findings were performed firstly in PI patients， between PFO and non-PFO， and then in patients with PFO， between PI and cortical infarction（CI）. Results A total of 251 patients were retrospectively analyzed. PFO was detected in 104 patients，of those，40.4%（42/104） had pure PI（PFO-PI） and 59.6%（62/104） had CI（PFO-CI）. In patients without PFO，30.6%（45/147） had pure PI（non-PFO-PI）.Compared with non-PFO-PI， PFO-PI associated with a higher proportion of vertebrobasilar circulation infarctions（VCI）（47.6% vs 17.8%， P=0.003）， lower mean value of left ventricle end-diastolic diameters（LVEDd）（47.3 mm vs 49.8 mm， P=0.037） and lower peak E-wave velocity（62.6 cm/s vs 70.8 cm/s，P=0.015）.In PFO patients， PFO-PI was detected with a lower mean value of aorta root diameters（32.5 mm，P=0.011） and lower mean value of LVEDd（47.3 mm，P=0.045） than PFO-CI（34.5 mm and 49.4 mm， respectively）. Conclusion Higher proportion of VCI was found in PFO-PI. Lower LVEDd， lower Em and without aortic root dilatation were three echocardiographic features associated with PFO-PI in cryogenic PI patients.