Prevalence of pulmonary embolism in patients with suspected cardioembolic ischemic stroke

Venous thromboemboli can cause both pulmonary embolism (PE) and paradoxical embolism in the presence of a cardiac right-to-left shunt. Our aim was to prospectively assess the prevalence of PE in patients with ischemic stroke with suspected cardiogenic etiology and thereby to clarify the possible role of paradoxical embolism as a cause of ischemic stroke.

Consecutive patients with suspected cardiogenic ischemic stroke (n=113, male/female=76/37, mean age 62±11 y) underwent computed tomography angiography of the pulmonary arteries to assess for the presence of PE as an adjunct to routine computed tomography angiography of the cervicocranial arteries. Transthoracic and transesophageal echocardiography were used to evaluate for patent foramen ovale (PFO) and cardiac defects.

PE was found in 4 patients (3.5%). Only 1 patient with PE had symptoms or signs suggestive of PE. None of the patients with PE had intracardiac defects or PFO. In the entire study population, atrial septal defect was detected in 5 (4%) patients and PFO in 13 (12%) patients.

The prevalence of PE in patients with ischemic stroke with suspected cardiogenic etiology is low. This study does not support a significant association between PE and cardiogenic ischemic stroke.