Percutaneous Transcatheter Embolization for Recurrent Cerebral Embolism Due to Pulmonary Arteriovenous Malformation

BACKGROUND Pulmonary arteriovenous malformations (PAVMs) are rare structural vascular abnormalities that create communications between pulmonary arteries and veins, resulting in right-to-left shunts. PAVMs are often asymptomatic; however, patients may exhibit a range of clinical symptoms, including dyspnea, hemoptysis, chest pain, and cyanosis. Common serious complications include cerebrovascular events (eg, paradoxical embolism resulting in stroke or transient ischemic attack) and infectious complications (eg, brain abscess). PAVMs do not always require treatment; management should be guided by factors such as feeding artery size and patient symptoms. When intervention is indicated, percutaneous transcatheter embolization is the primary treatment and demonstrates efficacy in most cases. This report describes a case of recurrent cerebral embolism attributed to an undiagnosed PAVM, which was treated with percutaneous transcatheter embolization. CASE REPORT A 67-year-old man lacking prior medical history or medication use experienced recurrent cerebral embolism within 3 months despite therapeutic anticoagulation. The paradoxical embolism was attributed to a PAVM diagnosed by contrast-enhanced chest computed tomography. Subsequent transcatheter embolization of the PAVM was successfully performed. No recurrence was observed at the 4-year follow-up. CONCLUSIONS In cases of unexplained cerebral embolism, PAVMs should be considered a potential underlying etiology. Hemorrhagic transformation requires careful risk assessment but is not an absolute contraindication to percutaneous transcatheter embolization. Timely diagnosis and embolization are essential to prevent disabling recurrent events.