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• W2026697488 abstract "Paradoxical embolism should only be diagnosed if three conditions are present: arterial embolism, a cardiac right-to-left shunt, and venous thrombosis. Whereas diagnosis of peripheral or cerebral arterial embolism is facilitated by computed tomography, angiography, and Duplex sonography, and cardiac right-to-left shunts is reliably diagnosed by transesophageal contrast echocardiography or transcranial Doppler sonography, there are only a few studies with a small number of patients that evaluate the role of the venous system in patients with suspected paradoxical embolism (Table 1) [ 1 Gautier JC Dürr A Koussa S Lascault G Grosgogeat Y Paradoxical cerebral embolism with a patent foramen ovale. A report of 29 patients. Cerebrovasc Dis. 1991; 1: 193-202 Crossref Google Scholar , 2 Stöllberger C Slany J Schuster I Leitner H Winkler W-B Karnik R The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism. Ann Intern Med. 1993; 119: 461-465 Crossref PubMed Scopus (194) Google Scholar , 3 Ranoux D Cohen A Cabanes L Amarenco P Bousser MG Mas JL Patent foramen ovale: is stroke due to paradoxical embolism?. Stroke. 1993; 24: 31-34 Crossref PubMed Scopus (229) Google Scholar , 4 Itoh T Matsumoto M Handa N Maeda H Hougaku H Tsukamoto Y Kondo H Tanouchi J Kamada T Paradoxical embolism as a cause of ischemic stroke of uncertain etiology. A transcranial Doppler sonographic study. Stroke. 1994; 25: 771-775 Crossref PubMed Scopus (38) Google Scholar , 5 Hanna JP Sun JP Furlan AJ Stewart WJ Sila CA Tan M Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention. Stroke. 1994; 25: 782-786 Crossref PubMed Scopus (157) Google Scholar , 6 Klötzsch C Janßen G Berlit P Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: experiences with 111 patients. Neurology. 1994; 44: 1603-1606 Crossref PubMed Google Scholar , 7 Rohr-Le Floch J Foramen ovale perméable et embolie paradoxale: une hyphothèse controversée. Rev Neurol (Paris). 1994; 150: 282-285 PubMed Google Scholar , 8 Lethen H Flachskampf FA Schneider R Sliwka U Köhn G Noth J Hanrath P Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. Am J Cardiol. 1997; 80: 1066-1069 Abstract Full Text PDF PubMed Scopus (176) Google Scholar ]. Several authors do not even mention screening for venous thrombosis as useful investigation in patients with suspected paradoxical embolism [ 9 Mas JL Diagnosis and management of paradoxical embolism and patent foramen ovale. Curr Opin Cardiol. 1996; 11: 519-524 Crossref PubMed Scopus (23) Google Scholar , 10 Lock JE Patent foramen ovale is indicted, but the case hasn't gone to trial. Circulation. 2000; 101: 838 Crossref PubMed Scopus (37) Google Scholar ]. From a diagnostic prerequisite for paradoxical embolism, venous thrombosis has been degraded to one of several “risk factors” [ 11 Dearani JA Ugurlu BS Danielson GK Daly RC McGregor CGA Mullany CJ Puga FJ Orszulak TA Anderson BJ Brown RD Schaff HV Surgical patent foramen ovale closure for prevention of paradoxical embolism-related cerebrovascular ischemic events. Circulation. 1999; 100: 171-175 PubMed Google Scholar , 12 Petty GW Khandheria BK Chu CP Sicks JD Whisnant JP Patent foramen ovale in patients with cerebral infarction. A transesophageal echocardiographic study. Arch Neurol. 1997; 54: 819-822 Crossref PubMed Scopus (64) Google Scholar , 13 Windecker S Wahl A Chatterjee T Garachemani A Eberli FR Seiler C Meier B Percutanenous closure of patent foramen ovale in patients with paradoxical embolism. Long-term risk of recurrent thromboembolic events. Circulation. 2000; 101: 893-898 Crossref PubMed Scopus (443) Google Scholar , 14 Hung J Landzberg MJ Jenkins KJ King MEE Lock JE Palacios IF Lang P. Closure of patent foramen ovale for paradoxical emboli: Intermediate-term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol. 2000; 35: 1311-1316 Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar ]. Confirming or excluding venous thrombosis in patients with suspected paradoxical embolism, however, is of therapeutic relevance and not only a matter of academic interest, because 1.Confirmation of venous thrombosis should entail anticoagulation or interventional therapy to protect the patient from recurrent paradoxical or pulmonary embolism. 2.Exclusion of venous thrombosis makes paradoxical embolism a rather unlikely diagnosis and should prompt a search for other etiologies of embolism. 3.Patent foramen ovale is a common finding with a prevalence of about 25% in the healthy population. Its diagnosis alone without venous diagnosis will provide no information on the risk of recurrent embolic events. Table 1Studies investigating the venous system in suspected paradoxical embolism Author (year of publication) Patients Technique Days between event and investigation Prevalence of thrombosis, % Location of thrombosis, n Gautier et al. (1991) [1] Gautier JC Dürr A Koussa S Lascault G Grosgogeat Y Paradoxical cerebral embolism with a patent foramen ovale. A report of 29 patients. Cerebrovasc Dis. 1991; 1: 193-202 Crossref Google Scholar 23 V a Venography. 2–210 26 Femoral, 3 Iliac, 3 Stöllberger et al. (1993) [2] Stöllberger C Slany J Schuster I Leitner H Winkler W-B Karnik R The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism. Ann Intern Med. 1993; 119: 461-465 Crossref PubMed Scopus (194) Google Scholar 42 V a Venography. 0–90 60 Calf, 13 Popliteal, 2 Femoral, 8 Iliac, 1 Ranoux et al. (1993) [3] Ranoux D Cohen A Cabanes L Amarenco P Bousser MG Mas JL Patent foramen ovale: is stroke due to paradoxical embolism?. Stroke. 1993; 24: 31-34 Crossref PubMed Scopus (229) Google Scholar 13 V a Venography. 0–28 0 0 Itoh et al. (1994) [4] Itoh T Matsumoto M Handa N Maeda H Hougaku H Tsukamoto Y Kondo H Tanouchi J Kamada T Paradoxical embolism as a cause of ischemic stroke of uncertain etiology. A transcranial Doppler sonographic study. Stroke. 1994; 25: 771-775 Crossref PubMed Scopus (38) Google Scholar 17 R b Radioisotope venography. ND c No data. 35 ND c No data. Hanna et al. (1994) [5] Hanna JP Sun JP Furlan AJ Stewart WJ Sila CA Tan M Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention. Stroke. 1994; 25: 782-786 Crossref PubMed Scopus (157) Google Scholar 16 V a Venography. or D d Duplex sonography. ND c No data. 31 ND c No data. Klötzsch et al. (1994) [6] Klötzsch C Janßen G Berlit P Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: experiences with 111 patients. Neurology. 1994; 44: 1603-1606 Crossref PubMed Google Scholar 27 V a Venography. or D d Duplex sonography. ND c No data. 11 ND c No data. Rohr-Le Floch (1994) [7] Rohr-Le Floch J Foramen ovale perméable et embolie paradoxale: une hyphothèse controversée. Rev Neurol (Paris). 1994; 150: 282-285 PubMed Google Scholar 18 V a Venography. 1–300 11 ND c No data. Lethen et al. (1997) [8] Lethen H Flachskampf FA Schneider R Sliwka U Köhn G Noth J Hanrath P Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. Am J Cardiol. 1997; 80: 1066-1069 Abstract Full Text PDF PubMed Scopus (176) Google Scholar 53 V a Venography. 1–15 9 ND c No data. a Venography. b Radioisotope venography. c No data. d Duplex sonography. Open table in a new tab" @default.
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