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

A 42-year-old woman with a C677T mutation in the methylenetetrahydrofolate reductase gene and a history of transient ischemic attack underwent transcatheter closure of an ostium secundum atrial septal defect (ASD-OS) using a Figulla Flex II device. Two years later, she presented with an ischemic stroke. Imaging revealed late embolization of the occluder device to the aorto-iliac bifurcation. As she remained asymptomatic, a conservative approach was adopted. A second transcatheter ASD-OS closure was successfully performed. This case underscores the potential contribution of inherited thrombophilia to recurrent embolic events, the importance of long-term surveillance for device complications, and the value of multimodal imaging in guiding clinical decision making.