Paradoxical Thromboembolic Ischemic Stroke Following Tissue Plasminogen Activator Instillation for Clogged Central Venous Dialysis Catheter

被引:3
作者
Nwosu, Ifeanyi [1 ]
Ibeson, Emeka [1 ]
Singh, Sehajpreet [1 ]
Singh, Ranbir [2 ]
Gulati, Amit [1 ]
Zadushlivy, Dmitriy [1 ]
Kupfer, Yizhak [3 ]
Derman, Anna [4 ]
Clemen, Britney [4 ]
Basnet, Arjun [1 ]
Nsofor, Geraldine [5 ]
Ogar, Annabel U. [6 ]
机构
[1] Maimonides Hosp, Internal Med, New York, NY 11219 USA
[2] Maimonides Hosp, Crit Care Med, New York, NY USA
[3] Maimonides Hosp, Crit Care, New York, NY USA
[4] Maimonides Hosp, Neuroradiol, New York, NY USA
[5] Milton Keynes Univ Hosp, Internal Med, Milton Keynes, Bucks, England
[6] Peterborough City Hosp, Internal Med, Peterborough, England
关键词
ischemic stroke; paradoxical embolism; patent foramen ovalis; tissue plasminogen activator; central venous dialysis catheter; PATENT FORAMEN OVALE; EMBOLISM;
D O I
10.7759/cureus.20346
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Central venous catheters including dialysis catheters are a potential source of venous thrombosis and pose a risk for paradoxical embolic events including ischemic stroke and systemic embolism in patients with a patent foramen ovale (PFO). The adult population with a PFO and patients with a central venous dialysis catheter (CVDC) are at increased risk of a paradoxical embolic event. Since bubble study is not routinely done during echocardiogram in a patient with CVDC, it is difficult to identify at-risk patients for paradoxical embolic events during catheter manipulation, especially for clogged CVDC. We report a rare case of a 79-year-old lady with end-stage renal disease on hemodialysis (HD) using a CVDC who developed a paradoxical embolic ischemic stroke following the use of tissue plasminogen activator (tPA) for unclogging a dialysis catheter. We aimed to highlight the existing risks of thromhoemholism associated with the long-term use of central CVDC, especially the potential risk of paradoxical embolism and ischemic stroke with the use of tPA for management of clogged dialysis catheters. We emphasize the questionable need for a bubble study echocardiogram in all patients requiring long-term dialysis catheters.
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页数:6
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