Key result
Amplatzer septal occluder develops device thrombosis and stroke ~23 years after implantation.
Why the study?
Very late device-related thrombosis following transcatheter atrial septal defect closure is exceedingly uncommon and not well characterized.
Case Report (n=1)
This case demonstrates that very late device-associated thrombosis can occur up to 23 years after Amplatzer ASD closure, suggesting a potential need for individualized, long-term surveillance in elderly patients with comorbidities.
May prompt evaluation for device thrombosis in late strokes after ASD closure; extends known timeline and leaves open surveillance needs.
Background: Device-related thrombosis is a rare but recognized complication following transcatheter atrial septal defect (ASD) closure, typically occurring within the first-year post-implantation. While early thrombus formation has been documented, very late presentations remain exceedingly uncommon. Case summary: We report a case of delayed device-associated thrombosis occurring 23 years after ASD closure with a 36 mm Amplatzer device. A 75-year-old female with multiple cardiovascular risk factors presented with acute left upper limb weakness, dysphagia, and slurred speech. Neuroimaging revealed infarcts in the right middle cerebral artery territory, consistent with an ischaemic stroke. Transthoracic echocardiography (TTE) identified a mass on the left atrial surface of the device. Transoesophageal echocardiography (TOE) confirmed a mobile thrombus on the right atrial surface and a sessile mass on the left atrial disc. There was no residual shunting. The patient was commenced on anticoagulation. Discussion: This case represents the most delayed instance of device-associated thrombosis reported to our knowledge. It highlights the diagnostic value of TOE when TTE is inconclusive and underscores the need for individualized anticoagulation strategies. Given the increasing use of transcatheter closure devices, this case raises important questions regarding the optimal duration of post-implantation surveillance, especially in elderly patients with comorbidities. A tailored follow-up approach may be warranted to mitigate late complications. Conclusion: Clinicians should maintain vigilance for device-associated thrombosis even decades after percutaneous ASD closure, particularly in patients with embolic phenomena. Extended surveillance imaging may be necessary in patients with significant comorbidities and risk factors.
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Tan et al. (2026) conducted a case report in Device-related thrombosis after atrial septal defect closure (n=1). Amplatzer Septal Occluder was evaluated on Device-associated thrombosis. An Amplatzer septal occluder device was complicated by very late device-associated thrombosis and ischemic stroke 23 years post-implantation in a 75-year-old female.
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