{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:17:24Z","timestamp":1787228244519,"version":"build-2736575974"},"reference-count":195,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Grant-in-Aid for Scientific Research (KAKENHI)","award":["23KF0126"],"award-info":[{"award-number":["23KF0126"]}]},{"name":"Grant-in-Aid for Scientific Research (KAKENHI)","award":["P23712"],"award-info":[{"award-number":["P23712"]}]},{"name":"Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan","award":["23KF0126"],"award-info":[{"award-number":["23KF0126"]}]},{"name":"Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan","award":["P23712"],"award-info":[{"award-number":["P23712"]}]},{"name":"MEXT and the Australian Academy of Science","award":["23KF0126"],"award-info":[{"award-number":["23KF0126"]}]},{"name":"MEXT and the Australian Academy of Science","award":["P23712"],"award-info":[{"award-number":["P23712"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>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\u2014such as immobility, endothelial dysfunction, and hypercoagulability\u2014with 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\u2014the Brain\u2013Lung Thromboinflammatory Axis Hypothesis\u2014which 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.<\/jats:p>","DOI":"10.3390\/ijms26146733","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T09:45:52Z","timestamp":1752572752000},"page":"6733","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pulmonary Embolism in Acute Ischaemic Stroke: Evolving Evidence, Diagnostic Challenges, and a Novel Thromboinflammatory Axis Hypothesis"],"prefix":"10.3390","volume":"26","author":[{"given":"Darryl","family":"Chen","sequence":"first","affiliation":[{"name":"Global Health Neurology Lab, Sydney, NSW 2150, Australia"},{"name":"UNSW Medicine and Health, University of New South Wales (UNSW), South West Sydney Clinical Campuses, Sydney, NSW 2170, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9783-3628","authenticated-orcid":false,"given":"Sonu M. M.","family":"Bhaskar","sequence":"additional","affiliation":[{"name":"Global Health Neurology Lab, Sydney, NSW 2150, Australia"},{"name":"NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia"},{"name":"Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Liverpool, NSW 2170, Australia"},{"name":"Department of Neurology & Neurophysiology, Liverpool Hospital and South West Sydney Local Health District, Liverpool, NSW 2150, Australia"},{"name":"Department of Neurology, Division of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center (NCVC), Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1055\/s-0038-1649503","article-title":"Global Burden of Stroke","volume":"38","author":"Katan","year":"2018","journal-title":"Semin. 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