<International Circulation>：What is it about stroke that causes PE?
Rabinstein：Immobility is certainly one of the major factors. A large majority of PE happens because of a preceding thrombosis， particularly in the legs. And in patients who are immobile because they are paralyzed are at a greater risk of developing clots in the leg. In the case of hemorrhagic stroke， whenever you are bleeding in the brain you have subsequent pro-coagulation situation in which the body is trying to heal. The coagulation cascade is activated and that can produce additional risk for thrombosis. So， those are factors and whether there are other factors other than stroke that increase the risk of DVT and PE remains more debated. The same responses that you would expect for the occurrence of PE in other populations are going to also apply without any major differences.

　　<International Circulation>：卒中导致PE的原因是什么？
Rabinstein：肢体不活动肯定是主要原因之一。大部分PE发生是由于之前已经存在血栓，尤其是下肢。因瘫痪而不能活动的患者下肢发生血栓的风险更高。如果大脑出血，那么随后身体处于促凝状态。凝血反应被激活，血栓形成的风险增加。卒中之外还有哪些增加DVT和PE风险的因素还有争议。其他人群中发生PE的反应在卒中患者中也存在，没有很大区别。

<International Circulation>：So when you have these complications with stroke and PE at the same， what can you do in that situation?
Rabinstein：When it’s a hemorrhagic stroke， it’s much more complicated. When an ischemic stroke， if the stroke is very large anticoagulation and thrombolysis may be problematic， but if it is a hemorrhagic stroke and it is a fresh， hemorhagic stroke then it’s really important because anticoagulation and thrombolysis are contraindicated. So in those cases is the PE is causing hemodynamic instability， biventricular failure， which can be potentially life-threatening， in those cases you have the option of an endovascular approach to try and mechanically take care of the clot. If you cannot anti-coagulate it the PE itself and it is not life-threatening we try and use intra-vena cava filters to try and prevent a new， PE until the patient can be safely anticoagulated.

　　<International Circulation>：如果发生卒中和PE，您会怎么做？
Rabinstein：如果是缺血性卒中，并且面积很大，那么抗凝治疗和溶栓治疗可能就有问题。如果是出血性卒中，问题就更复杂，出血性卒中有新鲜出血时，抗凝治疗和溶栓治疗就存在禁忌。因此在这些情况下，PE会导致血流动力学不稳定，心衰，会潜在危及生命。对于这些患者可以尝试进行血管内治疗，机械取栓。如果不能进行抗凝治疗，并且PE不危及生命，那么我们就尝试使用静脉内滤器，防止新PE形成，直到患者能够安全进行抗凝治疗。