From the Department of Neurology, University of Kentucky College of Medicine, Lexington, KY 40536-0284, USA.
J Neuroimaging. 2013 Jan;23(1):111-4. doi: 10.1111/j.1552-6569.2010.00568.x. Epub 2011 Jan 31.
Patent foramen ovale (PFO) has been associated with cryptogenic stroke, particularly in young adults. However, the source of particles leading to cerebral embolism remains frequently unknown despite comprehensive evaluation.
To report and comment on therapeutic options for 2 patients with acute ischemic strokes, PFO, and venous access related thrombosis, sources of paradoxical embolism, from Boston Medical Center stroke database.
Case 1. A 71-year-old man presented with brain magnetic resonance imaging (MRI) confirmed acute cerebellar infarction. Echocardiography showed a PFO and thrombotic material at the tip of a peripherally inserted central catheter (PICC) line in the superior vena cava (SVC) prolapsing into the right atrium (RA). Case 2. A 64-year-old woman with end-stage renal disease and PFO presented with brain MRI confirmed acute parietal lobe infarction. Three days prior to her stroke, she had thrombectomy and venoplasty of an arterio-venous (AV) dialysis graft followed by a post-thrombectomy fistulogram that showed persistent thrombotic material at the venous site.
PFO associated with large venous access site thrombosis was the most likely mechanism of stroke in both cases. Local thrombosis at sites of large venous access may be an overlooked source of paradoxical embolism in patients with PFO as well as a preventable cause of stroke in critically ill patients.
卵圆孔未闭（PFO）与隐源性卒中有关，尤其是在年轻成年人中。然而，尽管进行了全面评估，导致脑栓塞的颗粒来源仍常常未知。
报告并评论来自波士顿医疗中心卒中数据库的 2 例因 PFO 及与静脉通路相关的血栓形成、反常栓塞来源而发生急性缺血性卒中的患者的治疗选择。
病例 1. 一名 71 岁男性，因脑磁共振成像（MRI）证实的急性小脑梗死就诊。超声心动图显示卵圆孔未闭和位于上腔静脉（SVC）内的外周中心静脉导管（PICC）尖端的血栓形成物质突入右心房（RA）。病例 2. 一名 64 岁女性，终末期肾病合并 PFO，因脑 MRI 证实的急性顶叶梗死就诊。在她发生卒中前 3 天，她接受了动静脉（AV）透析移植物的血栓切除术和血管成形术，随后进行了血栓切除术后瘘管造影，显示静脉部位持续存在血栓形成物质。
这两例患者的卒中最可能的机制均为 PFO 合并大静脉通路部位血栓形成。大静脉通路部位的局部血栓形成可能是 PFO 患者反常栓塞的一个被忽视的来源，也是危重症患者卒中的一个可预防的原因。
