From the Department of Neurology (A.L.L., M.B.M., I.R., R.A.B., S.P.) and Department of Radiology (V.J.D., J.D.C., M.P.F.B., J.B.A., J.C.), Northwestern University-Feinberg School of Medicine, Chicago, IL; and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas (M.J.A).
Stroke. 2014 Aug;45(8):2324-9. doi: 10.1161/STROKEAHA.114.005539. Epub 2014 Jun 17.
Paradoxical embolization is frequently posited as a mechanism of ischemic stroke in patients with patent foramen ovale. Several studies have suggested that the deep lower extremity and pelvic veins might be an embolic source in cryptogenic stroke (CS) patients with patent foramen ovale.
Consecutive adult patients with ischemic stroke or transient ischemic attack and a patent foramen ovale who underwent pelvic magnetic resonance venography as part of an inpatient diagnostic evaluation were included in this single-center retrospective observational study to determine pelvic and lower extremity (LE) deep venous thrombosis (DVT) prevalence in CS versus non-CS stroke subtypes.
Of 131 patients who met inclusion criteria, 126 (96.2%) also had LE duplex ultrasound data. DVT prevalence overall was 7.6% (95% confidence interval, 4.1-13.6), pelvic DVT 1.5% (95% confidence interval, 0.1-5.8), and LE DVT 7.1% (95% confidence interval, 3.6-13.2). One patient with a pelvic DVT also had a LE DVT. Comparing patients with CS (n=98) with non-CS subtypes (n=33), there was no significant difference in the prevalence of pelvic DVT (2.1% versus 0%, P=1), LE DVT (6.2% versus 10.3%, P=0.43), or any DVT (7.2% versus 9.1%, P=0.71).
Among patients with ischemic stroke/transient ischemic attack and patent foramen ovale, the majority of detected DVTs were in LE veins rather than the pelvic veins and did not differ by stroke subtype. The routine inclusion of pelvic magnetic resonance venography in the diagnostic evaluation of CS warrants further prospective investigation.
卵圆孔未闭患者发生缺血性卒中时，常推测其发病机制为反常栓塞。有几项研究表明，隐源性卒中（CS）合并卵圆孔未闭患者的下肢深静脉和盆腔静脉可能是栓子的来源。
本单中心回顾性观察性研究纳入了连续接受住院诊断评估并接受盆腔磁共振静脉造影的缺血性卒中和短暂性脑缺血发作合并卵圆孔未闭的成年患者，以确定 CS 与非 CS 卒中亚型患者中盆腔和下肢（LE）深静脉血栓形成（DVT）的患病率。
符合纳入标准的 131 例患者中，126 例（96.2%）也有下肢双功超声数据。总体 DVT 患病率为 7.6%（95%置信区间，4.1-13.6），盆腔 DVT 为 1.5%（95%置信区间，0.1-5.8），下肢 DVT 为 7.1%（95%置信区间，3.6-13.2）。1 例盆腔 DVT 患者也存在下肢 DVT。CS 组（n=98）与非 CS 亚型组（n=33）相比，盆腔 DVT 患病率（2.1%与 0%，P=1）、下肢 DVT 患病率（6.2%与 10.3%，P=0.43）或任何 DVT 患病率（7.2%与 9.1%，P=0.71）均无显著差异。
在缺血性卒中和短暂性脑缺血发作合并卵圆孔未闭的患者中，大多数检测到的 DVT 位于下肢静脉，而不是盆腔静脉，且与卒中亚型无关。CS 诊断评估中常规纳入盆腔磁共振静脉造影需要进一步前瞻性研究。
