Impending Paradoxical Embolism

Incidental Thrombus in Transit Causing Embolic Stroke

“…Arterial embolization in this setting requires communication between the right and left heart, most commonly through a PFO. Paradoxical embolization is most often reported in the setting of pulmonary embolism which may lead to acutely increased right heart pressures favoring right-to-left shunting through a PFO [13]. Reports of thrombus in transit in the literature are most often described in patients undergoing diagnostic testing in the setting of a stroke [14].…”

Straddling interatrial embolus: a rare clinical dilemma

“…IPDE is associated with high mortality (16–18.4%) 1 2. Most deaths occur within 24 h of diagnosis with the major causes of death being cardiogenic shock (61%) and stroke (39%) 2…”

“…It is associated with the highest rate of arterial embolisation after commencement of treatment when compared with other treatment modalities. It is also associated with a non-statistically significant increase in mortality when compared with surgery 2. It is not clear whether this points to the inferiority of thrombolysis in this context or simply reflects the fact that patients treated with thrombolysis tended to be sicker.…”

“…An impending paradoxical embolism (IPDE) is a rare life-threatening condition with an estimated mortality of 16–18.4% 1 2. It occurs when a venous embolus is observed straddling the interatrial septum.…”

Impending paradoxical embolism across the interatrial septum

“…According to a statement from the American Heart Association, ( 4 ) surgical thrombectomy (particularly in patients with an intracardiac thrombus) might reduce the incidence of stroke, whereas thrombolysis might be associated with higher mortality. A recent systematic review ( 6 ) supported that recommendation by showing that the incidence of the composite endpoint of 30-day mortality or systemic embolism during treatment was lower among patients undergoing surgical thrombectomy than among those treated with anticoagulants alone (OR = 0.26; 95% CI, 0.11-0.60; p < 0.001). That incidence was not significantly lower in those undergoing thrombolysis (OR = 0.90; 95% CI, 0.28-2.86; p = 0.86).…”