Late Embolization of a Patent Foramen Ovale Occluder Successfully Retrieved Percutaneously

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.

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.

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.

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.