Unexpected paradoxical embolization following catheter-directed thrombectomy with the FlowTriever™ system in a patient with pulmonary embolism: a case report.

Nicola Anne Uecker, Stephan Rosenkranz, Alexander Bunck, Tobias Tichelbäcker

Open access · goldAbstract readCase Reports

In one paragraph

Article in European heart journal. Case reports, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it

0cells of the map it votes in

3citing papers in PubMed

1.1field-weighted citation impact, top 24% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 4 citations in OpenAlex.

Complications of catheter-directed interventions in acute pulmonary embolism: a narrative expert review with guidance on management.Cardiovascular diagnosis and therapy · 2026
Review
Mechanical thrombectomy for massive PE with incidental discovery of a patent foramen ovale: a case report.CVIR endovascular · 2026
Article
A patient with sudden pulmonary embolism and stroke after total hysterectomy and bilateral salpingo-oophorectomy was diagnosed with patent foramen ovale: case report and review.Frontiers in cardiovascular medicine · 2025
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Nicola Anne UeckerFaculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany.ORCID https://orcid.org/0000-0001-7024-923X

Stephan RosenkranzFaculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany.ORCID https://orcid.org/0000-0001-6237-1470

Alexander BunckFaculty of Medicine and University Hospital Cologne, Department of Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany.ORCID https://orcid.org/0000-0003-0986-0042

Tobias TichelbäckerFaculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany.ORCID https://orcid.org/0000-0002-5321-1819

University of Cologne · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: 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™ system, the only FDA-approved catheter system for percutaneous mechanical thrombectomy regarding this indication. Case Summary: 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. Discussion: 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.

Indexed as

Case reportMechanical thrombectomyPFOPulmonary embolismSystemic embolism

Identifiers

PMID36895302

DOI10.1093/ehjcr/ytad074

PMCPMC9991041

OpenAlexW4320486226

What OpenQuestion holds

Textmetadata

LicenceCC BY-NC

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.