# Successful treatment of acute device thrombosis of patent foramen ovale with slow infusion of low-dose thrombolytic therapy

## TL;DR

A 40-year-old woman with a patent foramen ovale device developed a blood clot, which was successfully treated with a slow infusion of low-dose t-PA.

## Contribution

This case report demonstrates the effectiveness of low-dose t-PA in treating acute PFO device thrombosis.

## Key findings

- Slow infusion of low-dose t-PA successfully lysed the thrombus in a PFO device.
- The treatment was administered without complications.
- Acute PFO device thrombosis can be effectively managed with low-dose thrombolytic therapy.

## Abstract

Percutaneous closure of patent foramen ovale (PFO) is used in selected individuals to eliminate the risk of recurrent cerebral embolism due to paradoxical embolization. Although device thrombosis is rare, it can cause serious complications. Herein, we report a 40-year-old woman who developed acute PFO closure device-associated thrombus and was subsequently treated with slow infusion of low-dose tissue plasminogen activator (t-PA) (25 mg/6 h).

A 40-year-old woman was admitted to the hospital because of an cerebrovascular accident (CVA). Computed tomography and magnetic resonance imaging of the brain demonstrated the presence of an ischaemic lesion in the right cerebellar infarct. Since no pathological finding was detected that could cause CVA, it was considered that there might be paradoxical embolism due to PFO. Percutaneous PFO closure was decided by the heart and brain team. The occluder was implanted under transoesophageal echocardiography (TEE) and fluoroscopy guidance. Although activated clotting time was 250 s, hypermobile acute thrombus measuring 11 × 5 mm was seen on the left atrial side of the PFO device. Slow infusion of low-dose t-PA treatment was given. As soon as after a single-dose t-PA, control TEE was performed and it was seen that almost the entire thrombus was lysed. The patient did not have any complications during the treatment period.

Acute PFO device thrombosis is a rare but important complication. If there is no contraindication for lytic treatment in acutely developing large PFO device thrombosis, slow infusion of low-dose t-PA may be useful.