Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study.
OBJECTIVE
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 mean+/-SD age was 46+/-10 years, and time from stroke onset to pelvic MRV scan was 49+/-16 hours. Compared with those with stroke of determined origin (n=49), patients with cryptogenic stroke (n=46) 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%, P<0.03), 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.
Cramer
Steven C
SC
University of Washington, Seattle, USA. scramer@uci.edu
Rordorf
Guy
G
Maki
Jeffrey H
JH
Kramer
Larry A
LA
Grotta
James C
JC
Burgin
W Scott
WS
Hinchey
Judith A
JA
Benesch
Curtis
C
Furie
Karen L
KL
Lutsep
Helmi L
HL
Kelly
Ellen
E
Longstreth
W T
WT
D000293:Adolescent; D000328:Adult; D015984:Causality; D015897:Comorbidity; D004452:Echocardiography; D019320:Embolism, Paradoxical / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010388:Pelvis / Q000098:blood supply*; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014680:Veins / Q000473:pathology*; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000453:epidemiology