title: May-Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale: an important clinical association.
abstract: 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.
authors.affiliation: Department of Interventional Cardiology and Vascular Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. tjkiernan@partners.org
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kiernan
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Cubeddu
authors.forename: Pablo
authors.initials: P
authors.lastname: Rengifo-Moreno
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.forename: MingMing
authors.initials: M
authors.lastname: Ning
authors.forename: Zareh N
authors.initials: ZN
authors.lastname: Demirjian
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.forename: Ferdinando S
authors.initials: FS
authors.lastname: Buonanno
authors.forename: Robert M
authors.initials: RM
authors.lastname: Schainfeld
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: 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