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Ischemic strokes due to pulmonary arteriovenous malformations: A systematic review

Srinath Ramaswamy1, Izabela Marczak2, Yohannes Mulatu2

  • 1Columbia University Medical Center, New York, USA.

Brain Circulation
|November 11, 2024
PubMed
Abstract

Insights

Pulmonary arteriovenous malformations (PAVMs) can cause strokes in young adults, often affecting multiple brain areas. Early screening for PAVMs in stroke patients is crucial for preventing recurrent events.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Radiology

Background:

  • Pulmonary arteriovenous malformations (PAVMs) are a known cause of acute ischemic strokes (AISs) via paradoxical embolism.
  • Clinical and imaging features of PAVM-related AIS are not well-characterized.
  • Understanding these features is vital for timely diagnosis and stroke prevention.

Purpose of the Study:

  • To systematically review the clinical and imaging characteristics of patients experiencing AIS due to PAVMs.
  • To identify key features that may aid in screening AIS patients for PAVMs.
  • To inform appropriate treatment strategies for preventing recurrent strokes.

Main Methods:

  • Systematic literature search of MEDLINE, EMBASE, and Web of Science databases up to October 2023.
  • Inclusion of patients of all ages with AIS attributed to PAVM, excluding studies without clinical data.
  • Data extraction included demographics, AIS characteristics (location, territories), and PAVM features (location, size, treatment).

Main Results:

  • A case of a 47-year-old female with cerebellar AIS and a right lower lobe PAVM treated with coil closure.
  • Analysis of 102 patients revealed a mean age of 47.4 years, with 67% females.
  • AIS commonly affected anterior circulation (50%) and posterior circulation (37%); PAVMs were typically single (78%) and in lower lobes (66%).
  • Hereditary hemorrhagic telangiectasia (HHT) was present in 33% of patients.

Conclusions:

  • PAVM-related strokes tend to occur in younger individuals.
  • These strokes exhibit a propensity for multifocal presentation and posterior circulation involvement.
  • Screening for HHT and venous thromboses is recommended for patients with PAVMs and AIS.
Keywords:
Embolic strokeischemic strokeparadoxical embolism

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