polidocanol and Stroke

Although foam sclerotherapy to varicose veins is now a popular treatment because of its high efficacy and safety, some neurologic complications have recently been reported. Presently, the effectiveness and safety of intravenous recombinant tissue-type plasminogen activator therapy to stroke following foam sclerotherapy remain unclear. Here, we report the case of a 68-year-old woman whose ischemic symptoms following foam sclerotherapy were treated by intravenous recombinant tissue-type plasminogen activator. After she was admitted, the venous thrombosis in her right soleus vein and a patent foramen ovale causing the right-to-left shunt were revealed. Thus, we diagnosed the ischemic symptoms were due to paradoxical embolism following foam sclerotherapy. After intravenous recombinant tissue-type plasminogen activator therapy, there was no complication and the outcome was good. Our case suggests the effectiveness and the safety of intravenous recombinant tissue-type plasminogen activator therapy to paradoxical embolism following foam sclerotherapy.

Topics: Administration, Intravenous; Aged; Embolism, Paradoxical; Female; Fibrinolytic Agents; Foramen Ovale, Patent; Humans; Polidocanol; Polyethylene Glycols; Recombinant Proteins; Sclerosing Solutions; Sclerotherapy; Stroke; Tissue Plasminogen Activator; Varicose Veins; Venous Thrombosis

Foam sclerotherapy is a safe, effective and increasingly widespread method of treating varicose veins. A case of ischemic stroke is described with reversible symptoms five days after polidocanol foam sclerotherapy was repeated in a 48-year-old female patient with a patent foramen ovale that was undetected at the time of sclerotherapy. The first foam sclerotherapy treatment had been tolerated well without complications. While acute neurological events immediately after sclerotherapy for varicose veins have been described repeatedly in the literature, this report is only the third case described worldwide of paradoxical embolism as a possible late complication of foam sclerotherapy for varicose veins.

Topics: Embolism; Female; Humans; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Stroke; Tissue Adhesives; Ultrasonography; Varicose Veins; Venous Insufficiency

This report describes an ischemic stroke after foam injection sclerotherapy of varicose veins in a patient with a patent foramen ovale. Foam injection sclerotherapy has created resurgence in the minimally invasive treatment of varicose veins. The United States Food and Drug Administration halted a clinical phase 2 trial of a commercial preparation of polidocanol microfoam in 2003 because of concerns relating to possible gas embolism. These trials were recommenced in July 2005. Neurologic complications such as transient visual disturbances and transient confusional states have previously been reported. This case, with its strong circumstantial evidence, illustrates the previously unconfirmed potential for embolic complications using this technique.

Topics: Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stroke; Varicose Veins