A Rare Stroke After Laser Resurfacing, and the Mechanism

Lasers in Surgery and Medicine reports a sixty-two-year-old woman who suffered an embolic stroke after full-field ablative Erbium:YAG resurfacing. The proposed mechanism is specific and worth understanding: significant pain during the procedure prompted a Valsalva maneuver, and a previously unknown patent foramen ovale allowed a clot to cross from the venous side to the arterial one. This is a single case report of a first-described event, so it says nothing about the general risk of resurfacing. What it does argue for is adequate anesthesia during ablative treatment, because pain that makes someone bear down is a mechanism and not just discomfort.