Combined Use of Noblestitch EL System and Amplatzer Device to Close a Patent Foramen Ovale With Complex Anatomy

Patent foramen ovale (PFO) is associated with crypto-genic stroke in young patients. In these cases, transcatheter PFO closure is indicated either with a device implantation or with a suture-mediated PFO closure system (NobleStitch EL, Kardia, Milan, Italy) to prevent further cerebral ischemic events. However, the presence of a complex anatomy might require advanced technical skills. We herewith describe the first case of combined use of the NobleStitch EL system with an Amplatzer PFO Occluder (Abbott Vascular, Abbott Park, IL) device to close a complex PFO characterized by a wide interatrial aneurysm, a long stiff tunnel, and a thickened septum secundum.