A 67-year-old man with recurrent cerebral embolism despite therapeutic anticoagulation was successfully treated with percutaneous transcatheter embolization of an undiagnosed pulmonary arteriovenous malformation, with no recurrence observed at 4-year follow-up.
Key Findings
Background
Recurrent cerebral embolism occurred within 3 months despite therapeutic anticoagulation in a patient with an undiagnosed pulmonary arteriovenous malformation.
The patient was a 67-year-old man with no prior medical history or medication use
Recurrence occurred within 3 months of the initial cerebral embolism event
The patient was on therapeutic anticoagulation at the time of recurrence
The paradoxical embolism mechanism was attributed to the right-to-left shunt created by the PAVM
Results
The pulmonary arteriovenous malformation was diagnosed using contrast-enhanced chest computed tomography.
The PAVM had not been previously diagnosed prior to the workup for recurrent cerebral embolism
Contrast-enhanced chest CT was the imaging modality used to identify the PAVM
The diagnosis was made in the context of unexplained recurrent cerebrovascular events
PAVMs create communications between pulmonary arteries and veins, resulting in right-to-left shunts
Results
Percutaneous transcatheter embolization of the PAVM was successfully performed and resulted in no recurrence at 4-year follow-up.
Transcatheter embolization was described as 'successfully performed'
No recurrence of cerebral embolism was observed at the 4-year follow-up
Percutaneous transcatheter embolization is described as 'the primary treatment' for PAVMs when intervention is indicated
The procedure 'demonstrates efficacy in most cases' according to the authors
Conclusions
Hemorrhagic transformation was identified as a risk consideration but not an absolute contraindication to percutaneous transcatheter embolization.
The authors state that 'hemorrhagic transformation requires careful risk assessment but is not an absolute contraindication to percutaneous transcatheter embolization'
This finding was drawn from the management of this specific case
The conclusion suggests embolization can proceed with appropriate risk stratification even in the presence of hemorrhagic transformation
Background
PAVMs can present asymptomatically and cause serious neurological complications including paradoxical embolism resulting in stroke or transient ischemic attack.
PAVMs are described as 'often asymptomatic'
Clinical symptoms when present may include 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)'
Management should be guided by factors such as feeding artery size and patient symptoms
PAVMs 'do not always require treatment'
What This Means
This case report describes a 67-year-old man who had a stroke and then suffered another stroke within three months, even though he was taking blood thinners as prescribed. Doctors eventually discovered the underlying cause was a pulmonary arteriovenous malformation (PAVM) — an abnormal connection between blood vessels in the lungs that creates a shortcut allowing blood clots to bypass the lungs' normal filtering system and travel directly to the brain. The PAVM was found using a special CT scan of the chest with contrast dye.
Once the PAVM was identified, doctors performed a minimally invasive procedure called transcatheter embolization, which blocks off the abnormal blood vessel connection using a catheter inserted through the skin. After this procedure, the patient had no further strokes over a 4-year follow-up period. This research suggests that PAVMs should be considered as a possible cause in any patient who has unexplained strokes, especially when standard blood-thinning treatments fail to prevent recurrence.
The authors also note that the presence of bleeding transformation in the brain (a complication sometimes seen after stroke) should be carefully evaluated before performing embolization but does not automatically rule out the procedure. This research suggests that timely identification and treatment of PAVMs through embolization is important to prevent future disabling strokes, and that this rare vascular abnormality should be part of the diagnostic workup when strokes occur without an obvious cause.
Qin X, Chen S, Li J, Wang Y, Niu H. (2026). Percutaneous Transcatheter Embolization for Recurrent Cerebral Embolism Due to Pulmonary Arteriovenous Malformation.. The American journal of case reports. https://doi.org/10.12659/AJCR.952379