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Incidence of pulmonary arteriovenous malformations among pediatric patients presenting with acute ischemic stroke

Matthew K McIntyre1, Huanwen Chen2, Diya Gandhi3

  • 1Department of Neurological Surgery, Oregon Health and Science University, Portland OR, USA.

European Journal of Radiology
|June 5, 2026
PubMed

Insights

The incidence of stroke and brain abscess in children with pulmonary arteriovenous malformations (pAVMs) and hereditary hemorrhagic telangiectasia (HHT) is lower than previously thought. This suggests reconsidering routine embolization for stroke prevention in these pediatric patients.

Area of Science:

  • Pediatric Neurology
  • Vascular Malformations
  • Genetics

Background:

  • Pulmonary arteriovenous malformations (pAVMs) are often associated with hereditary hemorrhagic telangiectasia (HHT).
  • Paradoxical embolization is a known risk, but the incidence of pediatric stroke and brain abscess in this population is not well-established.
  • Current clinical guidelines for pAVM management in children with HHT lack precise data on neurological complication risks.

Purpose of the Study:

  • To estimate the national incidence of acute ischemic stroke (AIS) and brain abscess among children diagnosed with HHT and pAVMs.
  • To provide data that can inform clinical decision-making regarding the prophylactic embolization of pAVMs in pediatric HHT patients.

Main Methods:

  • Retrospective analysis of the Kids' Inpatient Database (KID) from 2016, 2019, and 2022.
  • Inclusion criteria: pediatric patients (<18 years) hospitalized for AIS or brain abscess, identified using validated ICD-10 codes.
  • Incidence estimation based on U.S. Census data, published prevalence, and identified events in the KID database.

Main Results:

  • 23 cases (0.03%) of AIS were associated with HHT or pAVM diagnoses among 6,780 pediatric AIS hospitalizations.
  • Fewer than 11 cases of brain abscess were associated with HHT or pAVM diagnoses among 3,048 pediatric brain abscess hospitalizations.
  • Estimated annual incidence of AIS in children with HHT is ~0.05%, and for children with HHT and pAVMs, it is no more than 0.1%. Brain abscess incidence is estimated below 0.02-0.05%.

Conclusions:

  • The incidence of AIS and brain abscess in pediatric patients with HHT and pAVMs is lower than previously reported.
  • These findings suggest a need to re-evaluate the indications for pAVM embolization, focusing more on clinical significance rather than solely on routine stroke prevention.
  • Further research may refine risk stratification for neurological complications in pediatric HHT patients with pAVMs.
Abstract

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