Multidisciplinary Management for Concomitant High-Risk Pulmonary Embolism and Large-Vessel Occlusion Stroke From Paradoxical Embolism

Concurrent pulmonary embolism (PE) and acute ischemic stroke are uncommon but associated with high morbidity. Paradoxical embolism occurs when thrombi cross right-to-left cardiac/pulmonary shunts such as a patent foramen ovale. Early anticoagulation for PE may lead to hemorrhagic transformation in large acute ischemic strokes. Decisions for reperfusion therapies and anticoagulation are time-sensitive, with best outcomes achieved with a multidisciplinary approach. We present a patient with concurrent high-risk PE and right middle cerebral artery stroke from paradoxical embolism through a patent foramen ovale who received neurothrombectomy followed by pulmonary aspiration thrombectomy.