Unexpected Stroke Two Years After Atrial Septal Defect Closure: A Case of Late Device Embolization

Area of Science:

• Cardiovascular Medicine
• Genetics
• Neurology

Background:

• Atrial septal defects (ASD-OS) are sometimes closed using transcatheter devices.
• Inherited thrombophilias, like the MTHFR C677T mutation, can increase embolic event risk.
• Device embolization is a rare but serious complication of transcatheter procedures.

Purpose of the Study:

• To report a case of late device embolization after transcatheter ASD closure in a patient with thrombophilia.
• To highlight the importance of long-term surveillance and multimodal imaging in managing device-related complications.

Main Methods:

• Transcatheter closure of ostium secundum atrial septal defect (ASD-OS) using a Figulla Flex II device.
• Diagnostic imaging (e.g., CT, MRI) to identify device migration and assess embolic events.
• Clinical assessment and conservative management of asymptomatic device embolization.

Main Results:

• A 42-year-old woman with MTHFR C677T mutation and prior transient ischemic attack underwent successful ASD-OS closure.
• Two years post-procedure, she experienced an ischemic stroke due to late embolization of the closure device to the aorto-iliac bifurcation.
• The patient remained asymptomatic from the embolized device, and a second transcatheter ASD-OS closure was successfully performed.

Conclusions:

• Inherited thrombophilia may contribute to recurrent embolic events, even after successful defect closure.
• Long-term surveillance is essential to detect late complications of transcatheter closure devices.
• Multimodal imaging plays a vital role in guiding clinical decisions for device-related issues and embolic events.