肺动静脉瘘相关缺血性脑卒中5例分析

Analysis of 5 ischemic stroke patients caused by pulmonary arteriovenous fistula

目的探讨肺动静脉瘘与缺血性脑卒中的相关性,提高对于不明原因脑卒中的诊断及治疗水平。方法收集2017年1月至2020年12月中南大学湘雅医院收治的5例肺动静脉瘘所致缺血性脑卒中患者,结合文献资料总结肺动静脉瘘所致缺血性脑卒中的临床诊治及预后。结果5例患者中男性1例,女性4例,年龄(34.4±9.3)岁。以一侧肢体乏力、吐词不清、视力改变、眼睑下垂等为脑卒中首发表现,脑卒中发生部位不定。5例患者均为孤立性的肺动静脉瘘,其中位于左下肺3例、左上肺1例、右下肺1例。对5例患者均行介入治疗,术后6个月、12个月随访发现,所有患者均未再发新的缺血性脑卒中,仅1例患者右心声学造影检查提示分流量为Ⅲ级,考虑存在再通可能。结论肺动静脉瘘是少见血管病变,其所致脑卒中更为少见,临床表现缺乏特异性。对于年轻的不明原因栓塞性脑卒中患者,如果脑卒中呈突然起病,前后循环均可累及,并常累及多个血管分布区域,且难以找到明确栓子依据,存在低氧血症等表现,需考虑肺动静脉瘘可能。经皮导管介入治疗肺动静脉瘘安全有效,是目前治疗肺动静脉瘘的首选方法。

Objective To investigate the correlation between pulmonary arteriovenous fistula(PAVF)and ischemic stroke,and to improve the diagnosis and treatment of embolic strokes of undetermined source.Methods Five patients with ischemic stroke caused by PAVF admitted to Xiangya Hospital of Central South University from January 2017 to December 2020 were collected.The diagnosis,treatment and prognosis of stroke caused by PAVF were summarized based on literature review.Results Among the 5 patients,1 is male and 4 are females,with age of(34.4±9.3)years.Weakness of unilateral limb,slurred speech,vision changes,drooping eyelids,etc.,were the first manifestations of stroke.The location of cerebral infarction was indefinite.In this study,5 patients were all isolated PAVF,including 3 cases of left lower lung,1 case of left upper lung and 1 case of right lower lung.All 5 patients underwent interventional therapy,were followed-up for 6 months and 12 months after surgery,and none of them had a new stroke attack,and only 1 case had recanalization of PAVF.Conclusions PAVF is a rare vascular lesion,stroke caused by which is even rarer,with a lack of specificity in clinical manifestations.For young patients with unexplained embolic stroke,if the stroke has a sudden onset,the anterior and posterior circulation can be involved,and multiple vascular distribution regions are often involved,and it is difficult to find a clear emboli basis,with manifestations such as hypoxemia,PAVF should be considered.Percutaneous catheter intervention for PAVF is safe and effective,and is the preferred method for the treatment of PAVF.