Why the study?
Concurrent PE and acute ischemic stroke from paradoxical embolism are uncommon and have high morbidity, with early anticoagulation risking hemorrhagic transformation and requiring time-sensitive reperfusion decisions.
Sequential neurothrombectomy and pulmonary aspiration thrombectomy can be a viable multidisciplinary approach for managing concurrent high-risk PE and large-vessel occlusion stroke from paradoxical embolism.
Multidisciplinary care may aid time-sensitive decisions in concurrent PE and stroke; leaves open optimal anticoagulation timing after reperfusion.
Concurrent pulmonary embolism (PE) and acute ischemic stroke are uncommon but associated with high morbidity. Paradoxical embolism occurs when thrombi cross right-to-left cardiac/pulmonary shunts such as a patent foramen ovale. Early anticoagulation for PE may lead to hemorrhagic transformation in large acute ischemic strokes. Decisions for reperfusion therapies and anticoagulation are time-sensitive, with best outcomes achieved with a multidisciplinary approach. We present a patient with concurrent high-risk PE and right middle cerebral artery stroke from paradoxical embolism through a patent foramen ovale who received neurothrombectomy followed by pulmonary aspiration thrombectomy.
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Vo et al. (2025) studied this question.
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