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Increased Pelvic Vein Thrombi in Cryptogenic Stroke Results of the Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) Study

Increased Pelvic Vein Thrombi in Cryptogenic Stroke Results of the Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) Study,Steven C. Cra

Increased Pelvic Vein Thrombi in Cryptogenic Stroke Results of the Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) Study   (Citations: 39)
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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 meanSD age was 4610 years, and time from stroke onset to pelvic MRV scan was 4916 hours. Compared with those with stroke of determined origin (n49), patients with cryptogenic stroke (n46) 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%, P0.03), 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. (Stroke. 2004;35:46-50.) studies have found that such cryptogenic stroke patients have an increased prevalence of patent foramen ovale (PFO) compared with patients with stroke of determined origin or normal control subjects, and a meta-analysis found this increase to be most significant in younger patients. 4 A PFO is an interatrial communication that might allow thromboemboli to pass from the right to the left side of the heart. Patients with PFO-related stroke have an increased prevalence of inherited thrombophilic disorders.5 In patients with cryptogenic stroke, features of brain imaging are often suggestive of embolus.2,6 These facts together suggest that passage of venous thrombus to the cerebral arterial circulation might be the mechanism of stroke in some patients whose infarct is currently classified as cryptogenic, particularly younger patients. However, this formulation has been criticized because a venous source of thrombus has uncommonly been found in patients with stroke and PFO.7
Published in 2011.
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