Jan Niclas Strickling

Medcare Hospital, United Arab Emirates

Title: First-In-Centre Percutaneous Closure of Patent Foramen Ovale for Secondary Stroke Prevention: A Case Report and Review of Current Evidence

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Biography

Objectives: Patent foramen ovale (PFO) is implicated in a substantial proportion of cryptogenic ischaemic strokes through paradoxical embolism. We report our institution's first percutaneous PFO occluder implantation, performed in a 40-year-old man presenting with an acute cryptogenic stroke, and review the evidence base guiding patient selection for transcatheter closure.

Methods: A 40-year-old male presented with an acute focal neurological deficit, confirmed as an acute ischaemic stroke on brain MRI. A comprehensive aetiological work-up — carotid and vertebral imaging, prolonged cardiac rhythm monitoring, transthoracic echocardiography, and thrombophilia/vasculitis screening — excluded alternative stroke mechanisms. Transoesophageal echocardiography confirmed a PFO with high-risk anatomical features, and risk stratification using the RoPE score and PASCAL classification supported a probable PFO-attributable stroke. Following joint neurology–cardiology review, the patient underwent percutaneous PFO closure via femoral venous access under transoesophageal and fluoroscopic guidance.

Results: Device deployment was uneventful, with confirmed bi-disc apposition, stable device position, and no residual shunt on completion bubble study. There were no procedural or immediate post-procedural complications, and the patient was discharged after overnight observation on dual antiplatelet therapy.

Conclusion: This first-in-center case demonstrates the feasibility and safety of percutaneous PFO closure for secondary stroke prevention and is concordant with landmark randomized trials (RESPECT, CLOSE, REDUCE, DEFENSE-PFO) and current AHA/ASA and SCAI guidance favouring closure in carefully selected patients aged 18–60 years with cryptogenic, non-lacunar stroke and high-risk PFO anatomy.

Structured risk stratification and multidisciplinary decision-making remain central to appropriate patient selection, and this case supports the establishment of a structured PFO closure pathway at our institution.

Abstract

Jan Niclas Strickling is a board-certified Interventional Cardiologist and Consultant for Cardiology and Internal Medicine at Medcare Al Safa Hospital, Dubai, UAE, with over 12 years of clinical experience at maximum-care hospitals in Germany. He holds DHA licensure as a Specialist in Interventional Cardiology and Consultant in Cardiology and Internal Medicine, together with DGK Additional Qualifications in Heart Failure, Special Rhythmology, and Interventional Cardiology. His practice spans complex coronary intervention, intracoronary imaging and physiology (OCT, IVL, FFR), and comprehensive cardiac device therapy, including pacemakers, ICDs, CRT, leadless pacemakers and conduction system pacing. He previously served as Head of the Department of Cardiac Device Therapy and Heart Failure at St. Marien Hospital Lünen, Germany. He currently serves as Medical Head of the German Medical Society Dubai and is a member of the DGK and ESC, and earned his medical degree from the University of Münster, Germany.