{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:38:33Z","timestamp":1788863913644,"version":"build-2803163510"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T00:00:00Z","timestamp":1629676800000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background\u2003<\/jats:title>\n                  <jats:p>Vein sclerosing therapy for varicose veins remains an extremely popular procedure. Cerebrovascular accidents can be a serious complication. A patent foramen ovale (PFO) can act as a conduit to the arterial circulation, which could explain the adverse neurologic consequence of this procedure. This case provides pathologic evidence of this concept.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary\u2003<\/jats:title>\n                  <jats:p>A 66-year-old female presented with syncope after undergoing varicose vein sclerotherapy. A computed tomography angiography of the head and neck in the emergency room revealed an occluded right distal M1 middle cerebral artery. Clot retrieval was performed with final pathology revealing amorphous material consistent with an exogenous agent, polidocanol foam, which was used for the patient\u2019s vein sclerotherapy. A transthoracic echocardiogram and transoesophageal echocardiogram showed a PFO, which was ultimately closed percutaneously.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\u2003<\/jats:title>\n                  <jats:p>In a quarter of the population, lack of closure of the intrauterine interatrial shunt leads to the existence of a PFO. This direct communication between the atria provides an anatomical conduit for paradoxical emboli and eventually infarction of affected tissues. While a paradoxical embolism is an uncommon cause of acute arterial occlusion, it can have catastrophic sequelae. Historically, the presence of an arterial thrombus from the venous circulation has been difficult to establish unless the thrombus is visualized in transit through a PFO. Complications from vein sclerotherapy have been reported in the literature and include transient ischaemic attacks and strokes, however, this is the first case to provide pathological proof of a paradoxical embolism, which ultimately resulted in percutaneous closure of the PFO.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab228","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T18:21:45Z","timestamp":1629742905000},"source":"Crossref","is-referenced-by-count":7,"title":["The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0463-2684","authenticated-orcid":false,"given":"Eileen C","family":"Gajo","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Rush University Medical Center, 1620 West Harrison Street, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford J","family":"Kavinsky","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Rush University Medical Center, 1620 West Harrison Street, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Murphy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Rush University Medical Center, 1620 West Harrison Stress, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6012-9648","authenticated-orcid":false,"given":"Hussam S","family":"Suradi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Rush University Medical Center, 1620 West Harrison Street, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,23]]},"reference":[{"key":"2021090613532032000_ytab228-B1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/j.1540-8175.2007.00583.x","article-title":"Patent foramen ovale in a large population of ischemic stroke patients: diagnosis, age distribution, gender, and race","volume":"25","author":"Gupta","year":"2007","journal-title":"Echocardiography"},{"key":"2021090613532032000_ytab228-B2","author":"Hakman","year":"2019"},{"key":"2021090613532032000_ytab228-B3","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/S0735-1097(85)80449-6","article-title":"Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery","volume":"5","author":"Nellessen","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2021090613532032000_ytab228-B4","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/S1010-7940(98)00251-6","article-title":"Diagnosis and management of entrapped embolus through a patent foramen ovale","volume":"14","author":"Aboyans","year":"1998","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021090613532032000_ytab228-B5","doi-asserted-by":"crossref","first-page":"4332","DOI":"10.1177\/0300060518789820","article-title":"Large thrombus-in-transit within a patent foramen ovale in a patient with pulmonary embolism: a case report","volume":"46","author":"Lu","year":"2018","journal-title":"J Int Med Res"},{"key":"2021090613532032000_ytab228-B6","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.jvs.2011.05.093","article-title":"Neurological complications of sclerotherapy for varicose veins","volume":"55","author":"Sarvananthan","year":"2012","journal-title":"J Vasc Surg"}],"container-title":["European Heart Journal - 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