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Ischemic Stroke Associated With Pulmonary Arteriovenous Malformations: Two Case Reports and a Literature Review

Gabriel García-Alcántara1, Rocío Vera-Lechuga1, Beatriz Martínez-García1

  • 1Department of Neurology and Stroke Unit.

The Neurologist
|October 30, 2025
PubMed
Abstract

Insights

Pulmonary arteriovenous malformations (PAVMs) can cause ischemic stroke through paradoxical embolisms. Embolization is the preferred treatment for PAVMs, followed by antiplatelet therapy for stroke prevention.

Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Pulmonary arteriovenous malformations (PAVMs) are rarely linked to ischemic stroke.
  • PAVMs typically cause medium (MeVOs) and distal vessel occlusions (DVOs), not large vessel occlusions (LVOs).
  • Isolated PAVMs can lead to paradoxical embolisms, contributing to stroke risk.

Purpose of the Study:

  • To present clinical cases of ischemic stroke associated with PAVMs.
  • To highlight diagnostic and treatment strategies for PAVMs causing stroke.
  • To emphasize the role of embolization and antiplatelet therapy in managing these conditions.

Main Methods:

  • Case report of two patients with ischemic stroke and PAVMs.
  • Diagnostic tools included Transcranial Doppler (TCD) with bubble test and transesophageal echocardiography (TEE).
  • Pulmonary computed tomography angiography (CTPA) confirmed PAVMs, followed by embolization treatment.

Main Results:

  • One patient experienced a stroke due to MeVO, successfully treated with intravenous thrombolysis (IVT).
  • TEE ruled out patent foramen ovale (PFO) in both patients.
  • PAVMs were confirmed and successfully treated with embolization, with no recurrent ischemic events during follow-up.

Conclusions:

  • PAVMs are an uncommon but significant cause of ischemic stroke.
  • Embolization is the primary treatment for PAVMs causing stroke.
  • Antiplatelet therapy is recommended post-embolization, with anticoagulation considered for specific cases.
Keywords:
embolizationischemic strokeparadoxical embolismpulmonary arteriovenous malformationstranscranial Doppler ultrasound

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