肺动静脉畸形与缺血性卒中的相关性

The Correlation between Pulmonary Arteriovenous Malformations and Ischemic Stroke

摘要: 在缺血性卒中患者中，肺动静脉畸形(PAVMs)是一个不可忽视的病因。尤其是常规胸部计算机断层扫描(CT)难以检出的微小PAVMs，是缺血性脑卒中(AIS)的重要但常被忽视的病因。PAVMs可导致缺血性卒中、脑脓肿、体循环栓塞、咯血等多种并发症；经胸对比超声心动图(TTCE)在PAVMs筛查(尤其是微小PAVMs)中具有高灵敏性，是卒中患者的重要筛查工具；推荐将TTCE纳入常规筛查流程，加强对微小PAVMs的识别。介入栓塞仍是核心治疗，而不可栓塞人群需以二级预防、缺铁纠正与随访为主，未来研究需要建立大规模前瞻性队列，以明确微小PAVM的卒中风险与管理策略。

Abstract: Pulmonary arteriovenous malformations (PAVMs) are a non-negligible etiology in patients with ischemic stroke. In particular, micro PAVMs, which are difficult to detect on conventional chest computed tomography (CT) scans, are an important but often overlooked cause of ischemic stroke (AIS); PAVMs can lead to a variety of complications such as ischemic stroke, cerebral abscess, circulatory embolism, hemoptysis, and others; Transthoracic Contrast Echocardiography (TTCE) is a sensitive tool for the screening of PAVMs, particularly micro PAVMs; it is recommended that TTCE be incorporated into the routine screening process for stroke patients; and it is recommended that TTCE be incorporated into the routine screening process. TTCE is an important screening tool for stroke patients; it is recommended that TTCE be incorporated into the routine screening process to enhance the identification of small PAVMs. Interventional embolization remains the core treatment, and secondary prevention, correction of iron deficiency, and follow-up are needed for the nonembolizable population; future studies need to establish large prospective cohorts to clarify the risk of stroke and management strategies for micro-PAVMs.