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Ten of the 13 reported patients recovered completely with no long-term sequelae. A right-to-left shunt and in particular a patent foramen ovale (PFO) was the most consistent risk factor. Paradoxical gas emboli were observed in the brain-supplying or the intra-cranial arteries of five patients with an immediate onset of stroke after foam sclerotherapy. Paradoxical clot embolism was suspected in three patients with a delayed onset of stroke and concurrent venous thrombosis. In the remaining five cases, which included two cases with an immediate onset after liquid sclerotherapy, no specific cause was identified. Patients with a past history of cryptogenic stroke or a long life history of recurrent classic migraine attacks (with aura) have a higher risk of neurological adverse events and may benefit from preoperative screening and percutaneous closure of PFO. <\/jats:p>","DOI":"10.1258\/phleb.2011.010098","type":"journal-article","created":{"date-parts":[[2011,9,4]],"date-time":"2011-09-04T00:23:52Z","timestamp":1315095832000},"page":"147-167","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":70,"title":["Paradoxical embolism, stroke and sclerotherapy"],"prefix":"10.1177","volume":"27","author":[{"given":"K","family":"Parsi","sequence":"first","affiliation":[{"name":"Phlebology Research Laboratory, Sydney Skin and Vein Clinic; University of New South Wales, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,9,2]]},"reference":[{"key":"bibr-PHLEB-10-098C1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)91270-X"},{"key":"bibr-PHLEB-10-098C2","first-page":"148","volume":"24","author":"Deichmann B","year":"1995","journal-title":"Phlebologie"},{"key":"bibr-PHLEB-10-098C3","first-page":"1935","volume":"29","author":"Kas A","year":"2000","journal-title":"Presse Med"},{"key":"bibr-PHLEB-10-098C4","first-page":"282","volume":"9","author":"Hanisch F","year":"2004","journal-title":"Eur J Med Res"},{"key":"bibr-PHLEB-10-098C5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2005.09.032"},{"key":"bibr-PHLEB-10-098C6","doi-asserted-by":"publisher","DOI":"10.1258\/phleb.2007.007073"},{"key":"bibr-PHLEB-10-098C7","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-009-9211-2"},{"key":"bibr-PHLEB-10-098C8","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a000013"},{"key":"bibr-PHLEB-10-098C9","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2009.179952"},{"key":"bibr-PHLEB-10-098C10","doi-asserted-by":"publisher","DOI":"10.1258\/phleb.2010.010044"},{"key":"bibr-PHLEB-10-098C11","first-page":"397","volume":"11","author":"Delaney M","year":"2010","journal-title":"West J Emerg Med"},{"key":"bibr-PHLEB-10-098C12","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.192218"},{"key":"bibr-PHLEB-10-098C13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.187998"},{"key":"bibr-PHLEB-10-098C14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2008.10.026"},{"key":"bibr-PHLEB-10-098C15","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.59.1.26"},{"key":"bibr-PHLEB-10-098C16","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.8.1172"},{"key":"bibr-PHLEB-10-098C17","doi-asserted-by":"publisher","DOI":"10.1016\/B978-012743170-3.50092-3"},{"key":"bibr-PHLEB-10-098C18","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.9.2087"},{"key":"bibr-PHLEB-10-098C19","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.50.4.895"},{"key":"bibr-PHLEB-10-098C20","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.18.6.997"},{"key":"bibr-PHLEB-10-098C21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2004.11.037"},{"key":"bibr-PHLEB-10-098C22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2006.03976.x"},{"key":"bibr-PHLEB-10-098C23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.291.6506.1384"},{"key":"bibr-PHLEB-10-098C24","doi-asserted-by":"publisher","DOI":"10.1258\/phleb.2008.008063"},{"key":"bibr-PHLEB-10-098C25","doi-asserted-by":"publisher","DOI":"10.1097\/00042728-200502000-00001"},{"key":"bibr-PHLEB-10-098C26","doi-asserted-by":"publisher","DOI":"10.1258\/phleb.2009.009068"},{"key":"bibr-PHLEB-10-098C27","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5891"},{"key":"bibr-PHLEB-10-098C28","unstructured":"National Institute for Health and Clinical Excellence. 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