A 55-year-old man presented with sudden occurrence of recurrent transitoric ischemic attacks with dysphasia and paresis of the left side in May 2004. Other than these symptoms, he presented in good physical condition, with no cyanosis or edema, and his ECG showed regular sinus rhythm at normal rate. Chest x-ray and laboratory studies were unremarkable. He was not taking medication.His medical history consisted of a patent foramen ovale (PFO) that had been closed 3 years earlier with the CardioSeal/Starflex Occluder (33 mm). The PFO was diagnosed because he had presented at the hospital with headache and vertigo. The CT scan of the head showed a small anterior inferior cerebellar infarction with no evidence of tumor or bleeding. Subsequent echocardiography revealed a PFO, and the patient was referred for implantation of the atrial septal defect (ASD) closure device. The immediate postprocedural medication of our center for this device included antiplatelet therapy with aspirin 300 mg daily for 6 months. At 2-year routine follow-up, the patient was doing well, with excellent physical exercise capacity and no neurological symptoms.