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double anti-aggregation therapy. The clinical follow-up at 4 months was satisfactory. The prevalence of PFO in patientswith a history of stroke ranges between 20% and 40%, and the estimated annual rate of recurrent ictus among PFO patients ranges between 1.5% and 12%, depending on the population studied. The optimal treatment for preventing strokes in PFO patients has not been identified. The international clinical practice guidelines recommend antiplatelet aggregation treatment for patients with transient ischemic attack and PFO, although it also could be indicated as an anticoagulant in other situations, such as atrial fibrillation: ‘‘[. . .] insufficient data exists [. . .] regarding the use of percutaneous closing devices for PFO in patients with their first ictus; this strategy could be considered for those patients who have suffered repeated cryptogenic strokes in spite of medical treatment.’’ During the percutaneous closure of a PFO, the total incidence of device thrombosis is small, varies according to the study, and also depends on the type of occluder used. In the Krumsdorf series (with 1000 patients [593 PFO and 407 with atrial septal defects] and TEE used during the procedure and at 4-week follow-up), the total rate was 6%. In the TEE study after 4 weeks, no thrombi were found in the 292 cases involving an Amplatzer occluder, 1 (1%) in 161Helex devices, 3 (7%) in 127 PFO-Star devices, and 7 (7%) in 100 CardioSEALs. Although the incidence was low, the best predictors for the thrombi formation were the presence of persistent atrial fibrillation and ASA. No increased benefit was observed when treating patients with a combination of aspirin and clopidogrel with respect to the group that received only aspirin as a thrombosis prophylaxis treatment. In general, thrombus was resolved through medical treatment in 17 of 20 patients within 4 weeks to 6months (warfarin and/or heparin); in 3, a surgical extraction of the thrombus was required. This case illustrates the usefulness of TEE during percutaneous structural procedures, as well as the need for intensive antiaggregant and anti-coagulant treatment in order to avoid complications in patients with thrombi.