[Paradoxical embolism: Myth or reality?]

Abstract

Paradoxical embolism should be suspected in front of a clinical phenomenon of thromboembolism associated with an anatomical right-to-left shunt. Others potential cardiac sources of thromboembolism must be ruled out. Strokes constitute the most frequent clinical manifestations of paradoxical embolism. Right-to-left left shunts are in connection with intracardiac defects (atrial septal defect and patent foramen ovale) or pulmonary arteriovenous malformations. The probability that a discovered PFO is stroke-related can be evaluated by a score. Therapeutic approaches for secondary prevention of recurrent stroke include antithrombotic and/or percutaneous treatments. The choice strategy begins to be clearer with the recent results of randomized controlled studies.

Keywords: Accident vasculaire cérébral; Atrial septal defect; Communication interauriculaire; Embolie paradoxale; Embolie systémique; Foramen ovale perméable; Malformations artérioveineuses pulmonaires; Paradoxical embolism; Patent foramen ovale; Pulmonary arteriovenous malformations; Right-to-left shunt; Shunt droit–gauche; Stroke; Systemic embolism.