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). Conclusion: CVPA may be used by the stroke team in the work-up of suspected paradoxical embolism among cryptogenic ischemic stroke patients with PFO.

Diagnostic Yield of Early Examination for Venous Thrombosis in Patients with Cryptogenic Stroke and a Right-to-left Shunt

“…In the present study, DVT was found in 29% of CS patients with an RLS. This is partially in concordance with previous research showing that 7-27% of CS patients with PFO had DVT (7)(8)(9)(10)(11)(12). The prevalence of DVT in CS patients with an RLS has varied widely because the rates of antithrombotic usage and the methods and timing of DVT evaluation differed among the previous studies.…”

Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

“…Prevalence of venous thrombosis among cryptogenic stroke patients varies considerably (7.2-40%) and is highly dependent on the type of imaging modality. 25 Although noninvasive testing for paradoxical embolism include lower extremity doppler ultrasound that detects superficial or deep venous thrombi, the study is impeded by limited sensitivity and reliance on the skills of ultrasound technician. 26 Venous thrombi -formed in thrombogenic conditions− precedes a paradoxical embolism via PFO and results in small distal infarcts without any visible large vessel occlusion on angiography.…”

Foramen oval permeable e ictus criptogénico

“…Otras variables de riesgo han sido detectadas en estudios randomizados (tamaño amplio del FOP, ASIA, hipermovilidad del septum interauricular) (12,16) y en estudios retrospectivos (válvula de Eustaquio prominente, red de Chiari, túnel largo del FOP) (17) . Lógicamente, un tromboembolismo pulmonar reciente o concomitante, o una fuente venosa de embolia al mismo tiempo que el ictus, sugieren la participación del FOP en el escenario clínico (18) . Asimismo, es importante considerar la actividad que estaba realizando el paciente (maniobras de fuerza) y su contexto clínico (inmovilización, cirugía mayor reciente, viaje prolongado en automóvil o en avión) (6) .…”