Increased Pelvic Vein Thrombi in Cryptogenic Stroke

Abstract

Background and Purpose-Cryptogenic stroke is associated with an increased prevalence of patent foramen ovale. The Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) study hypothesized that patients with cryptogenic stroke have an increased prevalence of pelvic deep venous thrombosis (DVT). Methods-At 5 sites, patients 18 to 60 years of age received an MRI venogram (MRV) of the pelvis within 72 hours of new symptom onset. Clinical data were then determined. Radiologists blinded to clinical data later read the scans. Results-The 95 patients who met entry criteria were scanned. Their meanϮSD age was 46Ϯ10 years, and time from stroke onset to pelvic MRV scan was 49Ϯ16 hours. Compared with those with stroke of determined origin (nϭ49), patients with cryptogenic stroke (nϭ46) were significantly younger, had a higher prevalence of patent foramen ovale (61% versus 19%), and had less atherosclerosis risk factors. Cryptogenic patients had more MRV scans with a high probability for pelvic DVT (20%) than patients with stroke of determined origin (4%, PϽ0.03), with most having an appearance of a chronic DVT. Conclusions-In this study of young stroke patients evaluated early after stroke, patients with cryptogenic stroke showed differences in several clinical features compared with patients with stroke of determined origin, including increased prevalence of pelvic DVT. The results require confirmation but suggest that paradoxical embolus from the pelvic veins may be the cause of stroke in a subset of patients classified as having cryptogenic stroke.

Is cryptogenic stroke a tenable diagnosis? The Milpark Hospital patent foramen ovale closure experience

“…(14) It appears that patients with PFO have an increased prevalence of pelvic vein thrombosis. (15) In this study of young patients with cryptogenic stroke, pelvic vein thrombosis was more prevalent than in controls (20% vs. 4%). This may be the true source of the embolus with the PFO being the conduit that allows the embolus to cross to the systemic circulation.…”

Hjerneinfarkt ved åpent foramen ovale

“…In the PELVIS study (Paradoxical emboli from large veins in ischemic stroke) a higher prevalence of pelvic vein thrombosis was found with MR venography in cases of cryptogenic stroke (20 %) than with ischaemic strokes of known etiology (4 %) (p < 0.025) (30).…”

Closure of patent foramen ovale for secondary prevention of cerebrovascular events

“…(22) So do an observational study of 202 patients with transvenous pacing leads, in whom the presence of intracardiac shunts was associated with a >2-fold increased risk of systemic embolism during longterm follow-up, (23) and a large Danish population based study on patients with deep venous thrombosis (n=25,199) or pulmonary embolism (n=16,925). Their relative risks of stroke during the first year after the thrombotic event were 2.2 (1.9-2.6) and 2.9 (2.3-3.7)…”