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

INTRODUCTION

Pulmonary arteriovenous malformations (PAVMs) are infrequently associated with ischemic stroke. PAVMs rarely cause large vessel occlusions (LVO), whereas medium (MeVOs) and distal vessel occlusions (DVOs) are more common. Isolated PAVMs are uncommon but may cause paradoxical embolisms.

CASE REPORTS: We describe 2 clinical cases of patients with ischemic stroke associated with PAVMs. One patient suffered a stroke caused by a MeVO and was successfully treated with intravenous thrombolysis (IVT). Transcranial Doppler ultrasound (TCD) with bubble test revealed a right-to-left shunt, but transesophageal echocardiography (TEE) ruled out a patent foramen ovale (PFO) in both patients. The presence of PAVMs was confirmed by pulmonary computed tomography angiography (CTPA), and they were successfully treated with embolization. The patients received antiplatelet therapy for secondary prevention, and no recurrence of ischemic events occurred during the follow-up period (12 mo for case 1 and 24 mo for case 2).

CONCLUSIONS

Pulmonary arteriovenous malformations are rarely associated with ischemic stroke. Embolization is considered the treatment of choice for these patients. After the procedure, antiplatelet therapy is generally recommended, although anticoagulation may be indicated in selected patients.