Ballvé-Martín A, Boned S, Rubiera M
Hospitals Vall d'Hebron, 08035 Barcelona, España.
Rev Neurol. 2020 Sep 1;71(5):186-190. doi: 10.33588/rn.7105.2020317.
Severe infection by SARS-CoV-2 has shown to entail an increased risk of thrombotic, especially venous, events. Central venous catheters have also been associated with an increased risk of thrombotic complications. Paradoxical embolism as an aetiological mechanism of ischaemic stroke should be considered in a highly prothrombotic context, where it may be more frequent.
A 40-year-old woman with a central venous catheter, with a large vessel ischaemic stroke, treated with mechanical thrombectomy for an atypical paradoxical embolism while in intensive care for bilateral COVID-19 pneumonia. In the aetiological study, analysis highlighted an elevation of the D-dimer and right-left shunt with massive passage of contrast directly from the central peripheral access pathway in the left upper extremity to the left atrium in the transoesophageal echocardiogram. Thoracic tomographic angiography showed an anomalous venous structure with its origin in the subclavian vein and drainage to the segmental vein of the left upper lobe with direct emptying into the left atrium. Treatment consisted in anticoagulation until removal of the central venous catheter and simple anti-aggregating medication on discharge.
Paradoxical embolism due to intra- or extra-cardiac shunt should be considered in patients with COVID-19, given the high associated risk of venous thromboembolism. Further studies are needed to be able to define optimal prophylactic and therapeutic management.
严重的新型冠状病毒2（SARS-CoV-2）感染已显示出会增加血栓形成的风险，尤其是静脉血栓事件。中心静脉导管也与血栓形成并发症风险增加有关。在高血栓形成倾向的情况下，应考虑反常栓塞作为缺血性中风的病因机制，在这种情况下它可能更常见。
一名40岁女性，有中心静脉导管，因双侧新冠肺炎肺炎在重症监护期间发生大血管缺血性中风，因非典型反常栓塞接受了机械取栓治疗。在病因学研究中，分析突出显示D-二聚体升高以及经食管超声心动图显示造影剂大量直接从左上肢的中心外周通路进入左心房的左右分流。胸部断层血管造影显示一种异常静脉结构，其起源于锁骨下静脉，引流至左肺上叶的段静脉并直接排空至左心房。治疗包括抗凝直至拔除中心静脉导管，并在出院时给予简单的抗聚集药物。
鉴于静脉血栓栓塞的高相关风险，新冠肺炎患者应考虑心内或心外分流导致的反常栓塞。需要进一步研究以确定最佳的预防和治疗管理方法。
