Authors

• Ana Crnjac — General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia — ORCID: 0009-0000-2784-0278
• Nataša Đurđević — General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia — ORCID: 0009-0006-2348-3262

Keywords

atrial septal defects, stroke, secondary prevention, interdisciplinary communication

DOI

Full Text

**Introduction**: Cryptogenic ischemic events in younger adults often prompt evaluation for a patent foramen ovale (PFO) or atrial septal defect (ASD). (1-4) We present a case highlighting coordinated neurology–cardiology decision-making, peri-procedural care, and structured follow-up. **Case report**: 49-year-old woman with arterial hypertension, dyslipidemia and previously corrected iron-deficiency anemia, experienced transient ischemic attacks in 2022 and August 2023, followed by right-sided hemisyndrome consistent with ischemic stroke in March 2024. Neuroimaging showed left hemispheric ischemia. Stroke work-up identified PFO; thrombophilia testing noted positive cardiolipin antibodies and suspected antithrombin deficit. Initial secondary prevention included aspirin and statin; clopidogrel intolerance was documented. A joint neurology–cardiology conference reviewed imaging, echocardiography (ICE/TEE), risk of paradoxical embolism, and competing etiologies. Given recurrent events and high RoPE features, percutaneous PFO closure was recommended. On 20-Nov-2024, under ICE and fluoroscopy guidance, a 25-mm Amplatzer PFO occluder was implanted via femoral venous access using the Minnesota maneuver and cable release; hemostasis was achieved without complications. Nursing staff coordinated peri-procedural monitoring, early mobilization, patient education, and discharge planning. Post-procedure antiplatelet therapy was tailored (ticagrelor plus low-dose aspirin for three months, then single antiplatelet therapy), with risk-factor optimization and home-based physical therapy. The patient was discharged in good general condition with sinus rhythm and no new neurological deficits. Early follow-up showed clinical stability; a plan for BP/lipid control, Holter monitoring, and coordinated cardiology–neurology visits was established. **Conclusion**: Structured, interdisciplinary pathways—from joint indication setting through device closure and personalized antithrombotic strategy—enable safe, effective secondary prevention in PFO-associated cerebrovascular events. Clear role delineation (neurology, interventional cardiology, nursing, rehabilitation, and laboratory medicine) is central to outcomes and patient experience.

Literature

1. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, et al. CLOSE Investigators. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med. 2017 September 14;377(11):1011–21. https://doi.org/10.1056/NEJMoa1705915
2. Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, et al. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med. 2017 September 14;377(11):1033–42. https://doi.org/10.1056/NEJMoa1707404
3. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, et al. RESPECT Investigators. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med. 2017 September 14;377(11):1022–32. https://doi.org/10.1056/NEJMoa1610057
4. Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021 July;52(7):e364–467. https://doi.org/10.1161/STR.0000000000000375