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Key Clinical Message  Systemic embolization is a dreaded complication of transvenous lead extraction ( TLE ), even without visible vegetations. Preoperative patent foramen ovale evaluation is important, justifying neurological surveillance or consideration of surgical extraction in selected cases. In case of stroke after  TLE , mechanical thrombectomy is a successful therapy, and should be readily available.

Acute stroke from paradoxical embolism of dense fibrous tissue following pacemaker lead extraction: salvation by mechanical thrombectomy