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Clinical/Scientific Notes
December 8, 2008
Letter to the Editor

STROKE FOLLOWING PULMONARY ARTERIOVENOUS FISTULA EMBOLIZATION IN A PATIENT WITH HHT

December 9, 2008 issue
71 (24) 2012-2014
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Letters to the Editor
6 March 2009
STROKE FOLLOWING PULMONARY ARTERIOVENOUS FISTULA EMBOLIZATION IN A PATIENT WITH HHT
Cornelis JJ Westermann, St Antonius Hospital
Johannes J Mager, Henk W Mauser, Tim Th C Overtoom

We read Felix et al.'s article with interest. [1] The authors conclude that prothrombotic factors in Hereditary hemorrhagic telangiectasia (HHT), especially after embolisation, may have led to thrombus formation and paradoxical embolism through non-embolized pulmonary arteriovenous malformations (PAVM).

We saw a similar case of a young girl with brain infarction after embolization of a singular PAVM. [2] It appeared that the embolus came from the embolised PAVM because the PAVM was also fed by the bronchial artery. This dual feeding of PAVMs has been described before. [3] Felix et al. did not discuss this potential cause of stroke after embolization of a PAVM in their article.

References

1. Felix S, Jeannin S, Goizet C et al. Stroke following pulmonary arteriovenous fistula embolization in a patient with HHT. Neurology 2008;71:2012-2014.

2. Mager JJ, Overtoom TThC, Mauser HW, Westermann CJJ. Early cerebral infarction after embolotherapy of a pulmonary arteriovenous malformation. JVIR 2001;12:122-123.

3.Sagara K, Miyazono M, Inoue H, Ueno K, Nishada H,Nakajo M. Recanalisation after coil embolisation of pulmonary arteriovenous malformations: study of longterm outcome and mechanism of recanalisation. Am J Roentgenol 1998;170:727-730

Disclosure: The authors report no disclosures.

6 March 2009
Reply from the author
Igor Sibon, Université de Bordeaux II

We thank Dr. Westermann et al. for their comments. Control angiography performed in our patient failed to demonstrate a persistent feeding of the PAVM that would have suggested a dual feeding. Thus we excluded this hypothesis and did not discuss it in the manuscript. However, we agree that embolus from the embolized PAVM due to a second feeding is a potential mechanism that should be evoked in similar cases when absence of dual feeding is not demonstrated.

Disclosure: The author reports no disclosures.

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Published In

Neurology®
Volume 71Number 24December 9, 2008
Pages: 2012-2014
PubMed: 19064885

Publication History

Published online: December 8, 2008
Published in print: December 9, 2008

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Authors

Affiliations & Disclosures

S. Felix
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
S. Jeannin, MD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
C. Goizet, MD, PhD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
J. B. Thambo, MD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
S. Giraud, MD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
H. Plauchu, MD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
M. Montaudon, MD, PhD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.
I. Sibon, MD, PhD
From the Departments of Clinical Neurosciences (S.F., S.J., C.G., I.S.), Cardiology (J.B.T.), and Radiology (M.M.), CHU Bordeaux; Université Victor Segalen Bordeaux 2 (C.G.), Laboratoire de Génétique Humaine; Service de Génétique Moléculaire et Médicale (S.G., H.P.), CHU Lyon; and Centre de Référence pour la Maladie de Rendu-Osler (H.P.), France.

Notes

Address correspondence and reprint requests to Dr. Igor Sibon, Département de Neurologie, CHU Pellegrin, Université de Bordeaux II, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France; [email protected]

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  5. Brain infarction after embolization of a pulmonary arteriovenous malformation with metallic coils, Diagnostic and Interventional Imaging, 98, 10, (747-748), (2017).https://doi.org/10.1016/j.diii.2017.02.008
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  7. Hereditary haemorrhagic telangiectasia: Pathophysiology, diagnosis and treatment, Blood Reviews, 24, 6, (203-219), (2010).https://doi.org/10.1016/j.blre.2010.07.001
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