Chen Darryl, Bhaskar Sonu M M
Global Health Neurology Lab, Sydney, NSW 2150, Australia.
UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia.
Int J Mol Sci. 2025 Jul 14;26(14):6733. doi: 10.3390/ijms26146733.
Pulmonary embolism (PE) is an under-recognised yet serious complication in patients with acute ischaemic stroke (AIS), contributing significantly to morbidity and mortality. The interplay of traditional risk factors-such as immobility, endothelial dysfunction, and hypercoagulability-with AIS-specific conditions, including atrial fibrillation, malignancy, and reperfusion therapies, complicates both diagnosis and management. Despite available prophylactic strategies, including low-molecular-weight heparin and intermittent pneumatic compression, their use remains limited by bleeding concerns and a lack of tailored guidelines. This review synthesises the current evidence on the incidence, risk factors, pathophysiology, diagnostic approaches, and preventive strategies for PE in AIS, identifying critical gaps in risk stratification and clinical decision-making. We propose a novel mechanistic framework--which posits that stroke-induced systemic inflammation, neutrophil extracellular trap (NET) formation, and pulmonary endothelial activation may drive in situ pulmonary thrombosis independent of deep vein thrombosis. This conceptual model highlights new diagnostic and therapeutic targets and underscores the need for stroke-specific VTE risk calculators, biomarker-guided prophylaxis, and prospective trials to optimise prevention and outcomes in this vulnerable population.
肺栓塞（PE）是急性缺血性卒中（AIS）患者中一种未得到充分认识但严重的并发症，对发病率和死亡率有显著影响。传统危险因素（如活动减少、内皮功能障碍和高凝状态）与AIS特异性情况（包括心房颤动、恶性肿瘤和再灌注治疗）之间的相互作用，使诊断和管理变得复杂。尽管有包括低分子量肝素和间歇性充气加压在内的预防性策略，但它们的使用仍因出血问题和缺乏针对性指南而受到限制。本综述综合了关于AIS患者中PE的发病率、危险因素、病理生理学、诊断方法和预防策略的现有证据，确定了风险分层和临床决策中的关键差距。我们提出了一个新的机制框架，该框架认为卒中诱发的全身炎症、中性粒细胞胞外陷阱（NET）形成和肺内皮激活可能驱动原位肺血栓形成，而与深静脉血栓形成无关。这个概念模型突出了新的诊断和治疗靶点，并强调了需要针对卒中的静脉血栓栓塞（VTE）风险计算器、生物标志物指导的预防以及前瞻性试验，以优化这一脆弱人群的预防措施和治疗结果。
