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(Stroke. 2004;35:46.)
© 2004 American Heart Association, Inc.

Original Contributions

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 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.).

Correspondence to Steven C. Cramer, MD, University of California-Irvine, Department of Neurology, UCI Medical Center, 101 The City Drive South, Bldg 53, Room 203, Orange, CA 92868-4280. 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

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