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A small pulmonary arteriovenous malformation as a cause of recurrent brain embolism

Kenichi Todo1, Hiroshi Moriwaki, Masahiro Higashi

  • 1Department of Cerebrovascular Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.

AJNR. American Journal of Neuroradiology
|March 24, 2004
PubMed

Insights

Recurrent paradoxical brain embolism was prevented by embolizing a small pulmonary arteriovenous malformation (PAVM). This suggests embolization may benefit patients with smaller PAVMs, not just those with larger feeding arteries.

Area of Science:

  • Cardiology
  • Neurology
  • Radiology

Background:

  • Paradoxical embolism occurs when a clot travels from the venous to the arterial system, often through cardiac or pulmonary shunts.
  • Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary arteries and veins, posing a risk for paradoxical embolism.

Observation:

  • A patient experienced recurrent paradoxical brain embolism originating from a small PAVM with a 1.8-mm feeding artery.
  • Standard guidelines recommend PAVM embolization only for lesions with feeding arteries larger than 3 mm.

Findings:

  • Successful embolization of the small PAVM effectively prevented further recurrent strokes in this patient.
  • The case demonstrates that even small PAVMs can mediate significant embolic events.

Implications:

  • PAVM embolization may be a viable treatment option for select patients with smaller PAVMs presenting with paradoxical embolism.
  • Current treatment guidelines for PAVMs may need reconsideration to include smaller lesions in specific clinical scenarios.

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