Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Sep 26;10(3):213-219.
doi: 10.4103/bc.bc_23_24. eCollection 2024 Jul-Sep.

Ischemic strokes due to pulmonary arteriovenous malformations: A systematic review

Srinath Ramaswamy  1 , Izabela Marczak  2 , Yohannes Mulatu  2 , Mohamed Eldokmak  2 , Alon Bezalel  3 , Ariana Otto  4 , Steven R Levine  2
Affiliations
Review

Ischemic strokes due to pulmonary arteriovenous malformations: A systematic review

Srinath Ramaswamy et al. Brain Circ. .

Abstract

Background: Pulmonary arteriovenous malformations (PAVMs) can cause acute ischemic strokes (AISs) through paradoxical embolism. The clinical and imaging features of AIS due to PAVMs have not been studied. We report a case and perform a systematic review of the clinical and imaging characteristics of patients with AIS due to PAVMs. This may provide clues to screen patients with AIS for PAVMs and treat them appropriately to prevent further strokes.

Materials and methods: MEDLINE, EMBASE, and Web of Science databases were searched from inception to October 2023. We included patients of any age with AIS attributed to PAVM. Studies without clinical data were excluded. Demographics, AIS characteristics (location and arterial territories), and PAVM characteristics (location, size, and treatment) were recorded.

Results: A 47-year-old female presented with acute vertigo and gait imbalance. Magnetic resonance imaging showed AIS in the right cerebellum. CT chest confirmed a PAVM in the right lower lobe. Endovascular coil closure was performed. We identified 102 patients from 96 records. The mean age was 47.4 ± 17 years (67% female). Seventy percent had single AIS and 30% had multiple. The location was anterior circulation in 50%, posterior in 37%, and both in 13%. The most common arterial territory was middle-cerebral (51%), followed by posterior-cerebral (25%). PAVMs were mostly single (78%) and in the lower lobes (66%). Thirty-three had hereditary hemorrhagic telangiectasia (HHT) (33%).

Conclusions: PAVM-related strokes occur at a young age and may have a high propensity for multifocality and posterior circulation location. Patients with PAVMs and AIS should be screened for HHT and venous thromboses.

Keywords: Embolic stroke; ischemic stroke; paradoxical embolism.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Magnetic resonance imaging of the brain: Acute ischemic stroke in the posterior inferior cerebellar artery territory on diffusion-weighted imaging
Figure 2
Figure 2
(a) Pulmonary arteriovenous malformation in the right lung lower lobe (arrows) on computed tomography pulmonary angiography. (b) Catheter angiogram showing coil placement in the pulmonary arteriovenous malformation
Figure 3
Figure 3
PRISMA flow diagram for new systematic reviews which included searches of databases. *Records in EMBASE and Web of Science that were duplicates from PUBMED were excluded based on the filter function in the search engine of the databases. **Retrospective/prospective studies, translational studies, systematic reviews, or case reports/series without sufficient patient-level data for inclusion in the final analysis
See this image and copyright information in PMC

References

    1. Shovlin CL, Condliffe R, Donaldson JW, Kiely DG, Wort SJ British Thoracic Society. British Thoracic Society clinical statement on pulmonary arteriovenous malformations. Thorax. 2017;72:1154–63. - PubMed
    1. Homma S, Messé SR, Rundek T, Sun YP, Franke J, Davidson K, et al. Patent foramen ovale. Nat Rev Dis Primers. 2016;2:15086. - PubMed
    1. Shovlin CL, Jackson JE, Bamford KB, Jenkins IH, Benjamin AR, Ramadan H, et al. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax. 2008;63:259–66. - PubMed
    1. Topiwala KK, Patel SD, Pervez M, Shovlin CL, Alberts MJ. Ischemic stroke in patients with pulmonary arteriovenous fistulas. Stroke. 2021;52:e311–5. - PubMed
    1. Fatania G, Gilson C, Glover A, Alsafi A, Jackson JE, Patel MC, et al. Uptake and radiological findings of screening cerebral magnetic resonance scans in patients with hereditary haemorrhagic telangiectasia. Intractable Rare Dis Res. 2018;7:236–44. - PMC - PubMed

LinkOut - more resources