Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcala, Madrid, Spain.
Emerg Radiol. 2020 Aug;27(4):433-439. doi: 10.1007/s10140-020-01772-7. Epub 2020 Mar 24.
High-risk PE can be complicated by the presence of a patent foramen ovale (PFO), which can lead to paradoxical systemic embolization, including cerebral embolism ultimately leading to acute ischemic stroke (AIS). Acute management is challenging given the competing benefits and risks of systemic thrombolysis. Herein, we aim to provide a review of clinical presentations, diagnostic findings, and treatment and outcome from the available literature, with the hopes of providing insight into treatment options. We followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search using PubMed/MEDLINE database, Cochrane Library, and Google Scholar for all reported cases/case series of concomitant high-risk PE and paradoxical ischemic stroke was conducted from inception to July 2019. Twenty-nine cases from 27 articles (26 single case reports, 1 case series of 3 patients) were included. There were 10 men and 19 women, ranging in age from 29 to 81 years (mean 56.1 ± 13.5 years). PFO was diagnosed in 89.7% of patients, mostly by transesophageal echocardiography. Treatment modalities included systemic thrombolysis (40%), anticoagulation alone (36%), surgical thrombectomy (16%), and percutaneous thrombectomy (8%). Overall mortality rate was 31%. Patients receiving thrombolysis and surgical thrombectomy had the most favorable outcome. Survival to discharge was 90% (9 out of 10), 100% (5 out of 5), and 50% (4 out of 8) in the systemic thrombolysis, surgical thrombectomy, and anticoagulation alone groups respectively. In the setting of combined high-risk PE and ischemic stroke, PFO can be detected in 90% of published cases. Thrombolysis and surgical thrombectomy seem to be effective management, but further studies are needed for validation.
高危肺栓塞（PE）可并发卵圆孔未闭（PFO），导致反常性体循环栓塞，包括脑栓塞，最终导致急性缺血性脑卒中（AIS）。鉴于全身溶栓治疗的获益和风险并存，急性管理颇具挑战性。在此，我们旨在根据现有文献，就临床表现、诊断发现、治疗和结局进行综述，以期为治疗选择提供深入了解。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）的指南。通过对 PubMed/MEDLINE 数据库、考科蓝图书馆和 Google Scholar 进行系统性文献检索，检索所有报告的并发高危 PE 和反常性缺血性脑卒中病例/病例系列，检索时间从建库至 2019 年 7 月。共纳入 27 篇文献中的 29 例（26 例为单个病例报告，1 例为 3 例的病例系列）。患者包括 10 例男性和 19 例女性，年龄 29-81 岁（平均 56.1±13.5 岁）。89.7%的患者通过经食管超声心动图诊断出 PFO，主要治疗方法包括全身溶栓（40%）、单独抗凝（36%）、外科血栓切除术（16%）和经皮血栓切除术（8%）。总死亡率为 31%。接受溶栓和外科血栓切除术的患者预后最佳。溶栓组、外科血栓切除术组和单独抗凝组患者的存活率分别为 90%（10 例中的 9 例）、100%（5 例中的 5 例）和 50%（8 例中的 4 例）。在高危 PE 合并缺血性脑卒中的情况下，90%的发表病例中可检测到 PFO。溶栓和外科血栓切除术似乎是有效的治疗方法，但需要进一步的研究来验证。
