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Xiao J, Poblete RA, Lerner A, Nguyen PL, Song JW, Sanossian N, Wilcox AG, Song SS, Lyden PD, Saver JL, Wasserman BA, Fan Z. MRI in the Evaluation of Cryptogenic Stroke and Embolic Stroke of Undetermined Source. Radiology 2024;311:e231934. [PMID: 38652031 PMCID: PMC11070612 DOI: 10.1148/radiol.231934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024]

Affiliation(s)

Jiayu Xiao From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Roy A. Poblete From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Alexander Lerner From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Peggy L. Nguyen From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Jae W. Song From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Nerses Sanossian From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Alison G. Wilcox From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Shlee S. Song From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Patrick D. Lyden From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Jeffrey L. Saver From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Bruce A. Wasserman From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)
Zhaoyang Fan From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland–Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.)

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Schneck MJ. Neurologic complications of venous thromboembolism. HANDBOOK OF CLINICAL NEUROLOGY 2021;177:261-267. [PMID: 33632445 DOI: 10.1016/b978-0-12-819814-8.00017-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]

Zietz A, Sutter R, De Marchis GM. Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale-A Review of the Literature. Front Neurol 2020;11:336. [PMID: 32431661 PMCID: PMC7214694 DOI: 10.3389/fneur.2020.00336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open

Abstract

Background: Venous thromboembolism (VTE) can occur simultaneously with a cryptogenic stroke (CS) linked to patent foramen ovale (PFO), given paradox thromboembolism as potential stroke cause. However, little is known on the frequency of concomitant VTE and CS. We aimed to review the literature on the frequency of VTE in patients with CS linked to PFO (primary aim) and of ischemic stroke (IS) among patients with pulmonary embolism (PE) (secondary aim).

Methods: We performed a Medline search for cohort studies, written in English, with the following characteristics: (a) enrolling patients hospitalized for an acute ischemic stroke undergoing a work-up for deep venous thrombosis (DVT) and/or PE. To be included in this review, a study had to have at least a subgroup of patients with PFO; (b) the time interval between the index stroke and the work-up had to be within 40 days and the studies had to differentiate between DVT and PE. For the secondary aim, studies had to include patients with acute PE, known PFO-status and routine brain imaging on admission or within 1 year.

Results: We found eight studies reporting on the frequency of VTE after an acute CS linked to PFO. Concerning DVT, the reported frequency ranged between 7 and 27%; concerning PE, it lied between 4.4 and 37%. Six studies assessed the frequency of ischemic brain lesions among patients with an acute PE. In all studies, the presence of PFO was associated with ischemic brain lesions, both at baseline and follow-up.

Conclusion: VTE can be detected in patients with CS linked to PFO. While –based on the presented literature–routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.

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Shiraishi T, Sakai K, Mitsumura H, Arai A, Sato T, Komatsu T, Omoto S, Murakami H, Iguchi Y. Diagnostic Yield of Early Examination for Venous Thrombosis in Patients with Cryptogenic Stroke and a Right-to-left Shunt. Intern Med 2020;59:1023-1028. [PMID: 32295996 PMCID: PMC7205525 DOI: 10.2169/internalmedicine.3736-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open

Wiktor DM, Carroll JD. The Case for Selective Patent Foramen Ovale Closure After Cryptogenic Stroke. Circ Cardiovasc Interv 2018;11:e004152. [DOI: 10.1161/circinterventions.117.004152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]

Abstract Controversy has persisted for over a decade whether transcatheter patent foramen ovale (PFO) closure reduces the rate of recurrent ischemic stroke for patients who have had a cryptogenic ischemic stroke and have a PFO. In September 2017, 3 positive randomized trials: RESPECT long-term (Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment trial), REDUCE (GORE® HELEX® Septal Occluder / GORE® CARDIOFORM Septal Occluder and Antiplatelet Medical Management for Reduction of Recurrent Stroke or Imaging-Confirmed TIA in Patients With Patent Foramen Ovale [PFO]), and CLOSE (Patent Foramen Ovale Closure or Anticoagulants Versus Antiplatelet Therapy to Prevent Stroke Recurrence) were published. All 3 trials studied young to middle age patients with cryptogenic ischemic strokes found to have a PFO, and compared recurrent stroke rates after PFO closure versus medical therapy alone. All trials had primary end points of recurrent ischemic strokes, a superiority design, and reported results in the intention to treat population. The long-term results of the RESPECT trial led to the Food and Drug Administration approval of the AMPLATZER PFO Occluder for a secondary prevention indication. There was a 45% risk reduction in the device arm for recurrent ischemic stroke with an event rate of 0.58 versus 1.07 per 100 patient-years (hazard ratio, 0.55; 95% confidence interval, 0.305–0.999; log-rank P =0.046). The primary efficacy result of the REDUCE trial utilizing the HELEX and CARDIOFORM devices demonstrated a risk reduction of 77% (hazard ratio, 0.23; 95% confidence interval, 0.09–0.62; log-rank P =0.001). In the CLOSE trial, device closure plus long-term antiplatelet therapy versus antiplatelet therapy alone demonstrated a risk reduction of 97% (hazard ratio, 0.03; 95% confidence interval, 0–0.25; log-rank P <0.001). Each trial demonstrated a low frequency of device- and procedure-related complications, including a slight increase in the rate of paroxysmal atrial fibrillation in the device arm. This review focuses on summarizing the trial results and translating the results and methods from investigative trials into clinical practice. Collapse

Osgood M, Budman E, Carandang R, Goddeau, Jr. RP, Henninger N. Prevalence of Pelvic Vein Pathology in Patients with Cryptogenic Stroke and Patent Foramen Ovale Undergoing MRV Pelvis. Cerebrovasc Dis 2015;39:216-23. [DOI: 10.1159/000376613] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/29/2015] [Indexed: 11/19/2022] Open

Abstract Background: A substantial proportion of ischemic strokes has no any identified underlying cause. Notably, the prevalence of a patent foramen ovale (PFO) is increased in cryptogenic stroke (CS) populations, which may serve as a conduit for paradoxical emboli originating from deep vein thrombosis (DVT) including the pelvic veins. Yet, there are no published guidelines for the assessment of pelvic veins as part of the stroke workup and few studies have systematically investigated pelvic veins as a potential source for paradoxical emboli in CS patients. Further, there is a relative paucity of data regarding pelvic DVT in CS and results have been conflicting. Hence, we sought to determine the prevalence of pelvic DVT in select CS patients with PFO who underwent magnetic resonance venography (MRV). Methods: We retrospectively identified patients (n = 50) who underwent contrast-enhanced pelvic MRV at the discretion of the treating physician for the evaluation of CS in the presence of a PFO during hospitalization at a single academic stroke center between January 2011 through December 2013. Multivariable logistic regression analyses were used to assess for factors independently associated with the presence of an abnormal MRV pelvis. Results: Patients (47 ± 13 years of age) had MRV performed 4 ± 3 days after their incident stroke. Nine patients had an abnormal MRV (18%). Of these, four (8%) had pelvic vein thrombosis and 5 (10%) a May-Thurner anatomic variant. All patients with pelvic DVT were subsequently anticoagulated with warfarin (none had abnormal hypercoagulability testing). Clinical clues suggesting paradoxical embolism were present in as many as 40% of patients. On multivariable logistic regression, a history of any risk factors predisposing to DVT (OR 6.7; coefficient 1.9; BCa 95% CI 0.08-20.2; p = 0.014) as well as the number of predisposing risk factors (OR 3.9; coefficient 1.4; BCa 95% CI 0.25-4.2; p = 0.005) predicted the presence of pelvic vein pathology on MRV. Conclusion: We demonstrate a relatively high prevalence of pelvic DVT among select CS patients emphasizing the importance of considering the pelvic veins as a potential source for emboli particularly in the presence of risk factors known to predispose DVT. Because patients were included at the treating physician's discretion, our results reflect ‘real-life' practice. Our results may be of clinical importance as inclusion of pelvic vein imaging in CS patients with PFO had impactful therapeutic and nosologic implications. Further study is needed to define patients most likely to benefit from pelvic vein imaging. Collapse

Saremi F, Emmanuel N, Wu PF, Ihde L, Shavelle D, Go JL, Sánchez-Quintana D. Paradoxical Embolism: Role of Imaging in Diagnosis and Treatment Planning. Radiographics 2014;34:1571-92. [DOI: 10.1148/rg.346135008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]

Liberman AL, Daruwalla VJ, Collins JD, Maas MB, Botelho MPF, Ayache JB, Carr J, Ruff I, Bernstein RA, Alberts MJ, Prabhakaran S. Diagnostic Yield of Pelvic Magnetic Resonance Venography in Patients With Cryptogenic Stroke and Patent Foramen Ovale. Stroke 2014;45:2324-9. [DOI: 10.1161/strokeaha.114.005539] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Affiliation(s)

Ava L. Liberman 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)
Vistasp J. Daruwalla 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)
Jeremy D. Collins 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)
Matthew B. Maas 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)
Marcos Paulo Ferreira Botelho 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)
Jad Bou Ayache 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)
James Carr 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)
Ilana Ruff 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)
Richard A. Bernstein 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)
Marc J. Alberts 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 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)

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Reisman M. Patent Foramen Ovale: Closing Arguments⁎⁎Editorials published in JACC: Cardiovascular Interventions reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Interventions or the American College of Cardiology. Dr. Reisman is on the advisory boards of Coaptus Inc. and Ovalis Inc., and has received research grants from NMT Inc. and Coherex Medical Inc. JACC Cardiovasc Interv 2009;2:412-4. [DOI: 10.1016/j.jcin.2009.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/01/2009] [Accepted: 04/01/2009] [Indexed: 11/15/2022]

Kiernan TJ, Yan BP, Cubeddu RJ, Rengifo-Moreno P, Gupta V, Inglessis I, Ning M, Demirjian ZN, Jaff MR, Buonanno FS, Schainfeld RM, Palacios IF. May-Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale: an important clinical association. Stroke 2009;40:1502-4. [PMID: 19182088 DOI: 10.1161/strokeaha.108.527366] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

Abstract

BACKGROUND AND PURPOSE

We aimed to investigate the incidence of May-Thurner syndrome in patients with cryptogenic stroke with patent foramen ovale.

METHODS

This was a retrospective study. All consecutive patients with cryptogenic stroke having undergone patent foramen ovale closure from January 1, 2002, to December 31, 2007, at our institute were included in this study. Pelvic magnetic resonance venography studies of all patients were reviewed to determine if features of May-Thurner syndrome were present. Medical records and invasive venography studies of all patients were reviewed when available. All patients with May-Thurner syndrome features on magnetic resonance venography were reviewed by a vascular medicine specialist to define any previous incidence of deep vein thrombosis or any signs of chronic venous insufficiency. All patients also had lower limb venous duplex performed to rule out lower limb venous thrombosis.

RESULTS

A total of 470 patients from January 1, 2002, until December 31, 2007, with cryptogenic stroke underwent patent foramen ovale closure at our institute. Thirty patients (6.3%) had features consistent with May-Thurner syndrome on magnetic resonance venography. These patients were predominantly female (80%) with a mean age of 43.6+/-11.9 years. Twelve patients (40%) had abnormalities in their laboratory thrombophilia evaluation and 13 females (54.1%) were taking hormone-related birth control pills. Only 2 patients had a history and signs of chronic venous insufficiency. All patent foramen ovales demonstrated right-to-left shunting on transesophageal echocardiography. Atrial septal aneurysms/hypermobile atrial septa were present in 70% of patients with May-Thurner syndrome.

CONCLUSIONS

May-Thurner syndrome has an important clinical association with cryptogenic stroke and patent foramen ovale.

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Schrale R, Ormerod J, Wilson N, Ormerod O. PFO closure in pregnancy: A safe option for women and their fetuses. Catheter Cardiovasc Interv 2008. [PMID: 18311839 DOI: 10.1002/ccd.21373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]

Wada Y, Takahashi R, Yanagihara C, Nishimura Y. Paradoxical cerebral embolism as the initial symptom in a patient with ovarian cancer. J Stroke Cerebrovasc Dis 2007;16:88-90. [PMID: 17689401 DOI: 10.1016/j.jstrokecerebrovasdis.2006.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 09/29/2006] [Accepted: 10/16/2006] [Indexed: 12/15/2022] Open

Kerut EK, Lee S, Fox E. Diagnosis of an anatomically and physiologically significant patent foramen ovale. Echocardiography 2007;23:810-5. [PMID: 16999706 DOI: 10.1111/j.1540-8175.2006.00318.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open

Cramer SC. Patent Foramen Ovale and Stroke: Prognosis and Treatment in Young Adults. J Thromb Thrombolysis 2005;20:85-91. [PMID: 16205857 DOI: 10.1007/s11239-005-3202-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Cramer SC. Patent foramen ovale and its relationship to stroke. Cardiol Clin 2005;23:7-11. [PMID: 15676264 DOI: 10.1016/j.ccl.2004.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]

Ning M, Furie KL. Preventing a second stroke in the young. Top Stroke Rehabil 2004;11:40-50. [PMID: 15118966 DOI: 10.1310/xtbh-fgm2-7vne-x34a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]

Cramer SC, Rordorf G, Maki JH, Kramer LA, Grotta JC, Burgin WS, Hinchey JA, Benesch C, Furie KL, Lutsep HL, Kelly E, Longstreth WT. Increased Pelvic Vein Thrombi in Cryptogenic Stroke. Stroke 2004;35:46-50. [PMID: 14657451 DOI: 10.1161/01.str.0000106137.42649.ab] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]