Abstract Details

Title Prevalence And Associations of Ischemic Stroke with Pulmonary Arteriovenous Fistulas

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-021

Objective To determine the prevalence and management trends of acute ischemic stroke (AIS) in patients with pulmonary arteriovenous fistulae (PAVF), in the United States.

Background Pulmonary arteriovenous fistula (PAVF) is an abnormal intrapulmonary right-to-
left shunt. About 25% patients with untreated PAVF may suffer a paradoxical embolic acute
ischemic stroke (AIS) by 65 years of age. Current expert recommendations are to treat all CT
scan visible PAVF, even if asymptomatic. The American Heart Association Stroke Guidelines
recommend antiplatelets for secondary prophylaxis of AIS related to PAVF.

Design/Methods

Using the NIS from 2001-2014, patients carrying a secondary diagnosis of PAVF (ICD-9 CM code: 417.0) and a subsequent hospitalization with AIS were identified. SAS 9.4 was used for data analysis with categorical and continuous variables tested using the Chi-Square test and Student’s t-test, respectively. Cox proportional hazard regression was used to adjust for confounders.

Results A total of 4430 (weighted) patients (>18 years) were diagnosed with PAVF at a mean age of 55.6 years (SE ±0.7). About 7% (n=312, p<0.0001) patients with PAVF were admitted with AIS at a mean age of 58.5 years (SE ±2.5). On univariate analysis, epistaxis (p= 0.0184 OR 5.7), migraine (p= 0.0007, OR 5.7), patent foramen ovale (PFO) (p=0.0002, OR 3.2) and cannabis use (p= 0.009, OR 5.8) were significantly associated with AIS. Migraine (p=0.0062, OR 4.17) and PFO (p=0.0004, OR 3.68) retained significance on multivariate analysis. None of the ischemic strokes received reperfusion therapy. Only about 8% (n=24) were on long-term antiplatelet therapy. Approximately 3.2% (n= 141) of all patients with PAVF had a percutaneous embolization of their fistula.

Conclusions

A nationally representative sample showed low utilization of reperfusion therapy and secondary stroke prophylaxis with antiplatelet agents in patients with PAVF. Consensus guidelines and randomized control trials are need to establish the role of fistula embolization in these patients.

Authors/Disclosures
Ninad Desai, MBBS (Duke University) PRESENTER	Dr. Desai has nothing to disclose.
Karan K. Topiwala, MBBS (University of Minnesota)	No disclosure on file
Karan Tarasaria, MBBS	Dr. Tarasaria has nothing to disclose.
Mubashir Pervez, MD, MBBS, F�鶹��ýӳ�� (Cleveland Clinic)	Dr. Pervez has nothing to disclose.

�鶹��ýӳ��

�鶹��ýӳ��