Treatment of impending paradoxical embolism with systemic thrombolysis and cerebral embolic protection: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal: Case Reports Pub Date : 2025-08-12 eCollection Date: 2025-08-01 DOI:10.1093/ehjcr/ytaf391

Erika Tempo, Edoardo Bertero, Gabriele Crimi, Matteo Vercellino, Italo Porto

{"title":"Treatment of impending paradoxical embolism with systemic thrombolysis and cerebral embolic protection: a case report.","authors":"Erika Tempo, Edoardo Bertero, Gabriele Crimi, Matteo Vercellino, Italo Porto","doi":"10.1093/ehjcr/ytaf391","DOIUrl":null,"url":null,"abstract":"Background: Impending paradoxical embolism is a rare and life-threatening occurrence and evidence guiding its optimal management is lacking.Case presentation: A 73-year-old man presenting with ST-elevation myocardial infarction was diagnosed with impending paradoxical embolism, as a large thrombus was visualized entrapped in a patent foramen ovale. We performed systemic thrombolysis after deployment of a cerebral protection device, which resulted in complete dissolution of the thrombus without major thromboembolic events. Thrombolysis was complicated by development of intracranial haemorrhage that resolved without major neurological sequelae. The patient was discharged on a direct oral anticoagulant.Discussion: Treatment strategies for impending paradoxical embolism include surgical thrombectomy, percutaneous thrombus retrieval, and systemic thrombolysis. We report for the first time the effective use of a cerebral embolic protection device to reduce the risk of ischaemic injury to the brain during systemic thrombolysis.","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 8","pages":"ytaf391"},"PeriodicalIF":0.8000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374158/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal: Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjcr/ytaf391","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Impending paradoxical embolism is a rare and life-threatening occurrence and evidence guiding its optimal management is lacking.

Case presentation: A 73-year-old man presenting with ST-elevation myocardial infarction was diagnosed with impending paradoxical embolism, as a large thrombus was visualized entrapped in a patent foramen ovale. We performed systemic thrombolysis after deployment of a cerebral protection device, which resulted in complete dissolution of the thrombus without major thromboembolic events. Thrombolysis was complicated by development of intracranial haemorrhage that resolved without major neurological sequelae. The patient was discharged on a direct oral anticoagulant.

Discussion: Treatment strategies for impending paradoxical embolism include surgical thrombectomy, percutaneous thrombus retrieval, and systemic thrombolysis. We report for the first time the effective use of a cerebral embolic protection device to reduce the risk of ischaemic injury to the brain during systemic thrombolysis.

Abstract Image

查看原文本刊更多论文

全身性溶栓和脑栓塞保护治疗即将发生的矛盾栓塞1例报告。

背景：即将发生的矛盾栓塞是一种罕见且危及生命的事件，缺乏指导其最佳治疗的证据。病例介绍：一名73岁的男性，表现为st段抬高型心肌梗死，被诊断为即将发生的矛盾栓塞，因为一大块血栓被困在未闭的卵圆孔中。我们在部署脑保护装置后进行了全身溶栓，导致血栓完全溶解，无重大血栓栓塞事件。溶栓术并发颅内出血，但没有严重的神经系统后遗症。患者出院时使用直接口服抗凝剂。讨论：即将发生的矛盾栓塞的治疗策略包括手术取栓、经皮取栓和全身溶栓。我们首次报道了有效使用脑栓塞保护装置来降低全身溶栓过程中缺血性脑损伤的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊