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<p>This study reports the case of a 74-year-old female patient (aged 70 at the initial 2021 event) with hereditary thrombophilia and a patent foramen ovale (PFO) possessing high-risk anatomical features. The patient presented in December 2021 with pulmonary embolism and acute multiple cerebral infarctions due to PFO-associated paradoxical embolism. Genetic testing confirmed hereditary thrombophilia (plasminogen activator inhibitor-1, 4G/4G genotype). Despite standard anticoagulation, she developed recurrent thrombosis. Subsequent transesophageal echocardiography (May 2025) delineated the high-risk PFO anatomy. The Risk of Paradoxical Embolism (RoPE) score was 3, corresponding to a PFO‑attributable fraction of approximately 23%. This case illustrates a dual-risk mechanism for stroke: a persistent prothrombotic state coexisting with a definitive structural embolic pathway. The patient subsequently underwent percutaneous PFO closure. This case highlights the conflict between the need for individualized intervention based on dual high-risk mechanisms and the age-based recommendations of current guidelines (ESC 2023, AHA/ASA 2021). Anatomical assessment of the PFO enables a more precise estimation of stroke recurrence risk and the potential value of closure. As a causative therapy aimed at eliminating the structural embolic pathway, PFO closure may represent a reasonable interventional strategy in such carefully selected high-risk patients; however, its definitive net clinical benefit requires validation through prospective, large-scale trials.</p>

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Decision dilemmas and insights in secondary prevention of ischemic stroke: a case report of an elderly patient with hereditary thrombophilia and high-risk patent foramen ovale

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Xiaomin Xue,
  • Tianjie Zhang,
  • Ziqiang Yu,
  • Muhua Dai

摘要

This study reports the case of a 74-year-old female patient (aged 70 at the initial 2021 event) with hereditary thrombophilia and a patent foramen ovale (PFO) possessing high-risk anatomical features. The patient presented in December 2021 with pulmonary embolism and acute multiple cerebral infarctions due to PFO-associated paradoxical embolism. Genetic testing confirmed hereditary thrombophilia (plasminogen activator inhibitor-1, 4G/4G genotype). Despite standard anticoagulation, she developed recurrent thrombosis. Subsequent transesophageal echocardiography (May 2025) delineated the high-risk PFO anatomy. The Risk of Paradoxical Embolism (RoPE) score was 3, corresponding to a PFO‑attributable fraction of approximately 23%. This case illustrates a dual-risk mechanism for stroke: a persistent prothrombotic state coexisting with a definitive structural embolic pathway. The patient subsequently underwent percutaneous PFO closure. This case highlights the conflict between the need for individualized intervention based on dual high-risk mechanisms and the age-based recommendations of current guidelines (ESC 2023, AHA/ASA 2021). Anatomical assessment of the PFO enables a more precise estimation of stroke recurrence risk and the potential value of closure. As a causative therapy aimed at eliminating the structural embolic pathway, PFO closure may represent a reasonable interventional strategy in such carefully selected high-risk patients; however, its definitive net clinical benefit requires validation through prospective, large-scale trials.