Ava L Liberman1, Vistasp J Daruwalla1, Jeremy D Collins1, Matthew B Maas1, Marcos Paulo Ferreira Botelho1, Jad Bou Ayache1, James Carr1, Ilana Ruff1, Richard A Bernstein1, Marc J Alberts1, Shyam Prabhakaran2. 1. From the Department of Neurology (A.L.L., M.B.M., I.R., R.A.B., S.P.) and Department of Radiology (V.J.D., J.D.C., M.P.F.B., J.B.A., J.C.), Northwestern University-Feinberg School of Medicine, Chicago, IL; and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (M.J.A). 2. From the Department of Neurology (A.L.L., M.B.M., I.R., R.A.B., S.P.) and Department of Radiology (V.J.D., J.D.C., M.P.F.B., J.B.A., J.C.), Northwestern University-Feinberg School of Medicine, Chicago, IL; and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (M.J.A). shyam.prabhakaran@northwestern.edu.
Abstract
BACKGROUND AND PURPOSE: Paradoxical embolization is frequently posited as a mechanism of ischemic stroke in patients with patent foramen ovale. Several studies have suggested that the deep lower extremity and pelvic veins might be an embolic source in cryptogenic stroke (CS) patients with patent foramen ovale. METHODS: Consecutive adult patients with ischemic stroke or transient ischemic attack and a patent foramen ovale who underwent pelvic magnetic resonance venography as part of an inpatient diagnostic evaluation were included in this single-center retrospective observational study to determine pelvic and lower extremity (LE) deep venous thrombosis (DVT) prevalence in CS versus non-CS stroke subtypes. RESULTS: Of 131 patients who met inclusion criteria, 126 (96.2%) also had LE duplex ultrasound data. DVT prevalence overall was 7.6% (95% confidence interval, 4.1-13.6), pelvic DVT 1.5% (95% confidence interval, 0.1-5.8), and LE DVT 7.1% (95% confidence interval, 3.6-13.2). One patient with a pelvic DVT also had a LE DVT. Comparing patients with CS (n=98) with non-CS subtypes (n=33), there was no significant difference in the prevalence of pelvic DVT (2.1% versus 0%, P=1), LE DVT (6.2% versus 10.3%, P=0.43), or any DVT (7.2% versus 9.1%, P=0.71). CONCLUSIONS: Among patients with ischemic stroke/transient ischemic attack and patent foramen ovale, the majority of detected DVTs were in LE veins rather than the pelvic veins and did not differ by stroke subtype. The routine inclusion of pelvic magnetic resonance venography in the diagnostic evaluation of CS warrants further prospective investigation.
BACKGROUND AND PURPOSE: Paradoxical embolization is frequently posited as a mechanism of ischemic stroke in patients with patent foramen ovale. Several studies have suggested that the deep lower extremity and pelvic veins might be an embolic source in cryptogenic stroke (CS) patients with patent foramen ovale. METHODS: Consecutive adult patients with ischemic stroke or transient ischemic attack and a patent foramen ovale who underwent pelvic magnetic resonance venography as part of an inpatient diagnostic evaluation were included in this single-center retrospective observational study to determine pelvic and lower extremity (LE) deep venous thrombosis (DVT) prevalence in CS versus non-CSstroke subtypes. RESULTS: Of 131 patients who met inclusion criteria, 126 (96.2%) also had LE duplex ultrasound data. DVT prevalence overall was 7.6% (95% confidence interval, 4.1-13.6), pelvic DVT 1.5% (95% confidence interval, 0.1-5.8), and LE DVT 7.1% (95% confidence interval, 3.6-13.2). One patient with a pelvic DVT also had a LE DVT. Comparing patients with CS (n=98) with non-CS subtypes (n=33), there was no significant difference in the prevalence of pelvic DVT (2.1% versus 0%, P=1), LE DVT (6.2% versus 10.3%, P=0.43), or any DVT (7.2% versus 9.1%, P=0.71). CONCLUSIONS: Among patients with ischemic stroke/transient ischemic attack and patent foramen ovale, the majority of detected DVTs were in LE veins rather than the pelvic veins and did not differ by stroke subtype. The routine inclusion of pelvic magnetic resonance venography in the diagnostic evaluation of CS warrants further prospective investigation.