{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:31:50Z","timestamp":1770226310851,"version":"3.49.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The optimal therapy for patients suffering from acute pulmonary embolism (PE) classified as intermediate-high risk still needs to be identified. Catheter-directed thrombectomy (CDTE) is a safe procedure to reduce thrombus burden immediately. The lack of randomized trials is one reason: catheter-directed thrombolysis (CDT) has not yet received a clear recommendation in our guidelines. Herein, we report an unexpected event in the course of a patient with PE treated with CDTE using the FlowTriever\u2122 system, the only FDA-approved catheter system for percutaneous mechanical thrombectomy regarding this indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Summary<\/jats:title><jats:p>A 57-year-old male presented with dyspnoea at the emergency department of our university hospital. The computed tomography (CT) scan showed bilateral PE, and ultrasound of the left lower limb revealed deep venous thrombosis. According to the current ESC guidelines, he was classified intermediate-high risk. We performed bilateral CDTE. On the first and third day post-intervention, our patient presented neurological deficits. Whereas the first CT scan of the cerebrum remained normal, the CT scan at Day 3 showed demarcated embolic stroke. Further imaging diagnostic gave evidence to an ischemic lesion in the left kidney. Transesophageal echocardiography revealed a patent foramen ovale (PFO) as the origin of paradoxical embolism and thus mechanism of both ischemic lesions. Compliant to the current recommendations, percutaneous PFO closure was performed. Our patient recovered properly without any sequelae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Whether the deep venous thrombosis is the source of embolization or the catheter-directed retrieval of clots may have transported clot material to the right atrium which further on embolized systemically will remain unclear. Yet, we have to consider it as a potential complication in catheter-directed treatment of PE in patients with a PFO.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad074","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T16:52:35Z","timestamp":1676307155000},"source":"Crossref","is-referenced-by-count":4,"title":["Unexpected paradoxical embolization following catheter-directed thrombectomy with the FlowTriever\u2122 system in a patient with pulmonary embolism: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7024-923X","authenticated-orcid":false,"given":"Nicola Anne","family":"Uecker","sequence":"first","affiliation":[{"name":"Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne , Kerpener Str. 62, 50937 Cologne, NRW , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6237-1470","authenticated-orcid":false,"given":"Stephan","family":"Rosenkranz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne , Kerpener Str. 62, 50937 Cologne, NRW , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0986-0042","authenticated-orcid":false,"given":"Alexander","family":"Bunck","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital Cologne, Department of Radiology, University of Cologne , Kerpener Str. 62, 50937 Cologne, NRW , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5321-1819","authenticated-orcid":false,"given":"Tobias","family":"Tichelb\u00e4cker","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne , Kerpener Str. 62, 50937 Cologne, NRW , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,2,13]]},"reference":[{"key":"2023030719240943000_","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/eurheartj\/ehz405","article-title":"2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS)","volume":"41","author":"Konstantinides","year":"2020","journal-title":"Eur Heart J"},{"key":"2023030719240943000_","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1056\/NEJMoa1302097","article-title":"Fibrinolysis for patients with intermediate-risk pulmonary embolism","volume":"370","author":"Meyer","year":"2014","journal-title":"N Engl J 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embolism","volume":"44","author":"Bova","year":"2014","journal-title":"Eur Respir J"},{"key":"2023030719240943000_","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.jcin.2018.12.022","article-title":"A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism","volume":"12","author":"Tu","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"2023030719240943000_","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jcin.2020.09.053","article-title":"Indigo aspiration system for treatment of pulmonary embolism","volume":"14","author":"Sista","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2023030719240943000_","doi-asserted-by":"crossref","first-page":"e356","DOI":"10.1055\/s-0039-3401003","article-title":"Intermediate-high risk pulmonary embolism","volume":"03","author":"Mirambeaux","year":"2019","journal-title":"TH 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