title: Diagnostic Yield of Venous Thrombosis and Pulmonary Embolism by Combined CT Venography and Pulmonary Angiography in Patients with Cryptogenic Stroke and Patent Foramen Ovale.
abstract: BACKGROUND
  Paradoxical embolism via a patent foramen ovale (PFO) has been suggested as a potential stroke mechanism. Combined CT venography and pulmonary angiography (CVPA) is a simple, validated and accurate technique to diagnose deep venous thrombosis (DVT) or pulmonary embolism (PE). We sought to assess the prevalence of DVT or PE among patients with PFO and cryptogenic stroke (CS) by CVPA.
  
  
  METHODS
  Patients were identified retrospectively from a clinical registry of consecutive patients with stroke admitted to our Stroke Unit. The following criteria were required for inclusion in this study: CS, PFO identified by transthoracic echography using contrast medium and CVPA performed during the hospitalization following stroke.
  
  
  RESULTS
  A total of 114 patients with PFO underwent a CVPA within 7 days (interquartile range 4-9) from stroke symptom onset. On cerebral imaging, 11% had multiple infarcts. CVPA documented deep vein thrombosis (DVT) in 10 patients (8.8%) and PE in 5 patients (4.4%), that is, a total of 12 patients with prevalence of 10.5% (95% CI 5.5-17.7). Patients with PE-DVT had higher <smlcap>D</smlcap>-dimers and C reactive protein level than patients without PE-DVT (p < 0.05).
  
  
  CONCLUSIONS
  CVPA may be used by the stroke team in the work-up of suspected paradoxical embolism among cryptogenic ischemic stroke patients with PFO.
authors.affiliation: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Decroix
authors.forename: Serge
authors.initials: S
authors.lastname: Evrard
authors.forename: Adrien
authors.initials: A
authors.lastname: Wang
authors.forename: David
authors.initials: D
authors.lastname: Bendetowicz
authors.forename: Marie Astrid
authors.initials: MA
authors.lastname: Offroy
authors.forename: Philippe
authors.initials: P
authors.lastname: Graveleau
authors.forename: Stephanie
authors.initials: S
authors.lastname: Russel
authors.forename: Nassima
authors.initials: N
authors.lastname: Ramdane
authors.forename: François
authors.initials: F
authors.lastname: Mellot
authors.forename: Antoine
authors.initials: A
authors.lastname: Scherrer
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bourdain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D015995:Prevalence; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*