Risk of Recurrent Stroke Among Patients With Patent Foramen Ovale vs Pulmonary Arteriovenous Malformation: A Nationwide Study.

OBJECTIVES

Pulmonary arteriovenous malformation (pAVM) is an anatomical intrapulmonary left-to-right vascular shunt, and it may be a cause of paradoxical stroke. However, the risk of stroke associated with pAVMs is unknown. In this study, we seek to quantify the risk of stroke recurrence among cryptogenic stroke (CS) patients with pAVM compared with those with patent foramen ovale (PFO).

METHODS

This was a retrospective analysis of the 2016-2022 Nationwide Readmissions Database. Patients with acute ischemic stroke were identified, and those with embolic, thrombotic, lacunar, or other specified stroke etiologies were excluded to identify patients with CS. Recurrent stroke risk was compared between CS patients with PFO and pAVM using Cox regression models with multivariable adjustments for demographics, stroke severity, and stroke risk factors.

RESULTS

A total of 65,611 CS patients with PFO and 471 with pAVM were included. By 300 days, patients with pAVM had a 5.3% risk of recurrent stroke, which was not significantly different from 2.9% among patients with PFO after multivariable adjustments (HR 1.46 [95% CI 0.45-4.67], p = 0.53).

DISCUSSION: Among patients with CS, the presence of a pAVM may be reasonably considered equivalent to a PFO when estimating the risk of stroke recurrence.