A Rare Case of Paradoxical Embolization During Thrombolysis for Pulmonary Embolus

The most common intracardiac shunt is a patent foramen ovale (PFO) present in approximately 25% of adults [1]. See PDF.] Saddle embolus with multiple bilateral pulmonary artery filling defects Management One hundred milligrams of tissue plasminogen activator (tPA) infused over 2 h was started. Three recent randomized trials (CLOSE [6], REDUCE [5], and RESPECT [7] trials) showed that among adult patients aged 18–60 years with a cryptogenic ischemic stroke plus the presence of a PFO with a large right-to-left interatrial shunt (defined as > 25 microbubbles seen within three cardiac cycles [5]) and/or an associated atrial septal aneurysm, closure of PFO was associated with a lower rate of recurrent ischemic strokes than medical therapy alone during extended follow-up for up to 5 years. There are currently no guidelines from American Academy of Neurology, American College of Chest Physicians, and American Heart Association/American Stroke Association on how to manage patients with acute massive PE who concomitantly develop an acute ischemic stroke as this phenomenon is very rare.