Paradoxical Coronary Artery Embolism Through a Patent Foramen Ovale in a Young Adult

We describe the case of a 26-year-old man who presented with acute chest pain and was found to have single-vessel coronary occlusion most consistent with probable paradoxical embolism. Coronary angiography demonstrated complete occlusion of the ramus intermedius artery. Aspiration thrombectomy restored flow without stent implantation. Intravascular ultrasound showed no plaque rupture, atherosclerosis, or coronary dissection, supporting but not definitively confirming an embolic etiology. Transthoracic and transesophageal echocardiography subsequently identified a large patent foramen ovale with bidirectional shunting. Lower-extremity Doppler studies and an extensive hypercoagulable evaluation were negative. The patient later underwent successful percutaneous closure of the patent foramen ovale. This case highlights probable paradoxical coronary embolism as a rare cause of acute myocardial infarction in a young patient without significant atherosclerotic disease and underscores the value of multimodality imaging in supporting the diagnosis and guiding management.