Late Embolization of a Patent Foramen Ovale Occluder Successfully Retrieved Percutaneously.

BACKGROUND

Percutaneous patent foramen ovale (PFO) closure is an established therapy for secondary prevention of cryptogenic stroke. Device embolization is a rare but potentially serious complication, usually occurring early after implantation.

CASE SUMMARY: A 68-year-old woman underwent PFO closure after ischemic stroke. At 3-month follow-up, the device was not visualized on transthoracic or transesophageal echocardiography. Computed tomography angiography revealed embolization to the distal abdominal aorta. The device was successfully retrieved using a percutaneous snare technique; retrieval was complicated by an infrarenal aortic dissection that was managed conservatively. Three weeks later, the patient experienced recurrent ischemic stroke and underwent repeat PFO closure with a larger device, without further complications.

DISCUSSION: Percutaneous retrieval is a feasible first-line strategy in hemodynamically stable patients. Careful anatomical assessment and appropriate device sizing are essential to reduce the risk of embolization.

TAKE-HOME MESSAGES: This case highlights the importance of appropriate PFO occluder sizing in patients with PFO and atrial septum aneurysm to minimize the risk of device embolization. Although retrieval of a PFO occluder embolized into the aorta carries a risk of aortic wall injury, a percutaneous approach should be considered the first-line management strategy.