May-Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale: an important clinical association.
OBJECTIVE
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.
Kiernan
Thomas J
TJ
Department of Interventional Cardiology and Vascular Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. tjkiernan@partners.org
Yan
Bryan P
BP
Cubeddu
Roberto J
RJ
Rengifo-Moreno
Pablo
P
Gupta
Vishal
V
Inglessis
Ignacio
I
Ning
MingMing
M
Demirjian
Zareh N
ZN
Jaff
Michael R
MR
Buonanno
Ferdinando S
FS
Schainfeld
Robert M
RM
Palacios
Igor F
IF
D000328:Adult; D005260:Female; D054092:Foramen Ovale, Patent / Q000453:epidemiology*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000473:pathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology*; D019851:Thrombophilia / Q000453:epidemiology; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology