Published Online
on December 4, 2003

A more recent version of this article appeared on January 1, 2004

This Article Full Text (PDF) All Versions of this Article: 35/1/46    most recent 01.STR.0000106137.42649.ABv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cramer, S. C. Articles by Longstreth, W. T. Search for Related Content PubMed PubMed Citation Articles by Cramer, S. C. Articles by Longstreth, W. T., Jr Related Collections Deep vein thrombosis Echocardiography Acute Cerebral Infarction Other imaging Pathology of Stroke Primary and Secondary Stroke Prevention Risk Factors for Stroke Stroke in Children and the Young

Submitted on August 20, 2003
Accepted on September 10, 2003

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

Steven C. Cramer MD^*; Guy Rordorf MD; Jeffrey H. Maki MD, PhD; Larry A. Kramer MD; James C. Grotta MD; W. Scott Burgin MD; Judith A. Hinchey MD; Curtis Benesch MD; Karen L. Furie MD; Helmi L. Lutsep MD; Ellen Kelly AA; and W. T. Longstreth Jr MD

From the University of Washington, Seattle (S.C.C., J.H.M., E.K., W.T.L.); Massachusetts General Hospital, Boston (G.R., K.L.F.); University of Texas, Houston (L.A.K., J.C.G.); University of Rochester, Rochester, NY (W.S.B., J.A.H., C.B.); and Oregon Health and Science University, Portland (H.L.L.).

^* To whom correspondence should be addressed. E-mail: scramer{at}uci.edu.

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 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.

Key words: deep vein thrombosis • embolism, paradoxical • etiology • pathophysiology

This article has been cited by other articles:

				M.-R. Clergeau, M. Hamon, R. Morello, E. Saloux, F. Viader, and M. Hamon Silent Cerebral Infarcts in Patients With Pulmonary Embolism and a Patent Foramen Ovale: A Prospective Diffusion-Weighted MRI Study Stroke, December 1, 2009; 40(12): 3758 - 3762. [Abstract] [Full Text] [PDF]

				K. Rajamani, S. Chaturvedi, Z. Jin, S. Homma, R. L. Brey, B. C. Tilley, R. L. Sacco, J.L.P. Thompson, J.P. Mohr, S. R. Levine, et al. Patent Foramen Ovale, Cardiac Valve Thickening, and Antiphospholipid Antibodies as Risk Factors for Subsequent Vascular Events: The PICSS-APASS Study Stroke, July 1, 2009; 40(7): 2337 - 2342. [Abstract] [Full Text] [PDF]

				T. J. Kiernan, B. P. Yan, R. J. Cubeddu, P. Rengifo-Moreno, V. Gupta, I. Inglessis, M. Ning, Z. N. Demirjian, M. R. Jaff, F. S. Buonanno, et al. May-Thurner Syndrome in Patients With Cryptogenic Stroke and Patent Foramen Ovale: An Important Clinical Association Stroke, April 1, 2009; 40(4): 1502 - 1504. [Abstract] [Full Text] [PDF]

				J. Rodes-Cabau, M. Noel, A. Marrero, D. Rivest, A. Mackey, C. Houde, E. Bedard, E. Larose, S. Verreault, M. Peticlerc, et al. Atherosclerotic Burden Findings in Young Cryptogenic Stroke Patients With and Without a Patent Foramen Ovale Stroke, February 1, 2009; 40(2): 419 - 425. [Abstract] [Full Text] [PDF]

				S. Windecker and B. Meier Patent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else! Circulation, November 4, 2008; 118(19): 1989 - 1997. [Full Text] [PDF]

				E. Doufekias, A. Z. Segal, and J. R. Kizer Cardiogenic and aortogenic brain embolism. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1049 - 1059. [Abstract] [Full Text] [PDF]

				N U Weir An update on cardioembolic stroke Postgrad. Med. J., March 1, 2008; 84(989): 133 - 142. [Abstract] [Full Text] [PDF]

				S. Austin, H. Cohen, and N. Losseff Haematology and neurology J. Neurol. Neurosurg. Psychiatry, April 1, 2007; 78(4): 334 - 341. [Abstract] [Full Text] [PDF]

				M. R. Di Tullio, R. L. Sacco, R. R. Sciacca, Z. Jin, and S. Homma Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population J. Am. Coll. Cardiol., February 20, 2007; 49(7): 797 - 802. [Abstract] [Full Text] [PDF]

				E. Bedard, J. Rodes-Cabau, C. Houde, A. Mackey, D. Rivest, S. Cloutier, M. Noel, A. Marrero, J.-M. Cote, P. Chetaille, et al. Enhanced Thrombogenesis but Not Platelet Activation Is Associated With Transcatheter Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke Stroke, January 1, 2007; 38(1): 100 - 104. [Abstract] [Full Text] [PDF]

				J. R. Kizer and R. B. Devereux Clinical practice. Patent foramen ovale in young adults with unexplained stroke. N. Engl. J. Med., December 1, 2005; 353(22): 2361 - 2372. [Full Text] [PDF]

				H. Hara, R. Virmani, E. Ladich, S. Mackey-Bojack, J. Titus, M. Reisman, W. Gray, M. Nakamura, M. Mooney, A. Poulose, et al. Patent Foramen Ovale: Current Pathology, Pathophysiology, and Clinical Status J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1768 - 1776. [Abstract] [Full Text] [PDF]

				S. Cakmak, N. Nighoghossian, V. Desestret, M. Hermier, S. Cartalat-Carel, L. Derex, J. Honnorat, and P. Trouillas Pulmonary embolism: An unusual complication of cerebral venous thrombosis Neurology, October 11, 2005; 65(7): 1136 - 1137. [Full Text] [PDF]

				S. Homma and R. L. Sacco Patent Foramen Ovale and Stroke Circulation, August 16, 2005; 112(7): 1063 - 1072. [Full Text] [PDF]

				C. D. Bushnell and L. B. Goldstein Risk of ischemic stroke with tamoxifen treatment for breast cancer: A meta-analysis Neurology, October 12, 2004; 63(7): 1230 - 1233. [Abstract] [Full Text] [PDF]

				S. Windecker, A. Wahl, K. Nedeltchev, M. Arnold, M. Schwerzmann, C. Seiler, H. P. Mattle, and B. Meier Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke J. Am. Coll. Cardiol., August 18, 2004; 44(4): 750 - 758. [Abstract] [Full Text] [PDF]

				J. L. Blackshear Closure of patent foramen ovale in cryptogenic stroke: Ready or not, here come the trials J. Am. Coll. Cardiol., August 18, 2004; 44(4): 759 - 761. [Full Text] [PDF]

				C. E. Spritzer Progress in MR Imaging of the Venous System Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2002; 21(2): 105 - 116. [Abstract] [PDF]