Abstract W MP64: Evaluation of Deep Venous Thrombosis in Cryptogenic Stroke and Patent Foramen Ovale

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Vistasp Daruwalla ◽  
Deborah Bergman ◽  
Richard A Bernstein ◽  
Yvonne Curran ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Chi Square ◽  
Stroke Subtypes ◽  
Contrast Enhanced ◽  
Paradoxical Embolus ◽  
Stroke Mechanism

Background and Purpose: In cryptogenic stroke (CS), paradoxical embolus has been suggested as a stroke mechanism. A prior study found a significant rate of pelvic deep venous thrombosis (DVT) using magnetic resonance venography (MRV). We sought to evaluate the yield of diagnostic tests for lower extremity (LE) and pelvic DVT in stroke patients with patent foramen ovale (PFO) and in the subset with CS. Methods: A single center retrospective study was performed to identify consecutive ischemic stroke or TIA patients with PFO who underwent contrast-enhanced 3D pelvic MRV imaging (Ablavar, Lantheus Medical Imaging, N. Billerica, MA) between 2009 and 2013 as part of an inpatient diagnostic evaluation. Results of pelvic MRV, LE Doppler ultrasound (US) as well as clinical data were abstracted. Ischemic subtype was retrospectively assigned using the Causative Classification System (CCS). Patients with possible cardio-aortic embolism and undetermined cause by CCS were classified as CS. We estimated point estimates and 95% confidence intervals (CI) for DVT prevalence among stroke subtypes using the Wald method and compared these using Chi-square tests. Results: Of 130 patients who met study criteria, mean age was 56 +/- 17 years and median time from admission to MRV was 2 days (IQR 1-3). Overall DVT prevalence was 7.7% (95% CI, 4.1 to 13.7); the prevalence of pelvic DVT was 1.6% (95% CI, 0.07 to 5.8) and that of LE DVT was 7.2% (95% CI, 3.7 to 13.3). Of the patients with pelvic DVT (n=2), one patient also had a LE DVT by US. When MRV or US was obtained within 72 hours following admission, the prevalence of pelvic DVT was 2.1% (95% CI, 0.12 to 7.7) and that of LE DVT was 7.8% (95% CI, 3.8 to 14.8). Comparing patients with CS (n=97) to other subtypes (n=33), there was no difference in the prevalence of pelvic DVT (2.1% vs. 0%, P=1), LE DVT (6.3% vs. 10.3%, P=0.43) or any DVT (7.2% vs. 9.1%, P=0.71). Conclusion: Patients with CS and PFO have similar prevalence of DVTs compared to other stroke subtypes. The majority of detected DVTs were in LE veins rather than pelvic veins. Only a single patient with a pelvic DVT did not have a coexistent LE DVT. Our results suggest that the utility of pelvic MRV may be much lower than previously reported.

scholarly journals Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale

2018 ◽  
Vol 2018 (2) ◽  
Author(s):  
Dimitrios Panagopoulos ◽  
Sofia Loukopoulou ◽  
Evagelos Karanasios ◽  
Gerorgia Grigoriadou ◽  
Nikolaos Eleftherakis
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Anticoagulation Therapy ◽  
Unknown Etiology ◽  
Foramen Ovale ◽  
Arterial Ischemic Stroke ◽  
Radiological Investigation ◽  
Ultrasound Study

Arterial ischemic stroke (AIS), with an estimated incidence of 1.1–4.3 per 100,000, is an important cause of morbidity and mortality in children and the risk of recurrence is high. We present the case of an 11-year-old child who presented with a symptomatology of acute ischemic stroke of unknown etiology. The radiological investigation did not reveal any underlying brain abnormality that could cause the event. The diagnostic work up included an echocardiogram, which revealed a thrombus in the right atrium, in conjunction with a patent foramen ovale. The patient was initiated immediately on anticoagulation therapy with low molecular weight heparin and warfarin, but two days later she suffered pulmonary emboli, diagnosed with spiral thorax computed tomography (CT) scan. An ultrasound study of the vessels of the lower extremities revealed deep venous thrombosis (DVT), which was considered to be the underlying causative mechanism.

scholarly journals Right to left shunting detection by contrast-enhanced transcranial color-coded duplex among patients with cryptogenic stroke

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Samia Ashour Mohamed ◽  
Mohamed Ayman Saleh ◽  
Hala Mahmoud ELKhawas ◽  
Eman Saleh ElHadidi ◽  
Ahmed ElSadek ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Patent Foramen Ovale ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Contrast Enhanced ◽  
Ischemic Attack ◽  
Sensitive Method

Abstract Background Contrast-enhanced transcranial duplex (c-TCD) might be more sensitive than transesophageal echo (TEE) for detection of right to left shunting (RLS), which misses some cases with substantial RLS and might be valuable for prediction of recurrent stroke or transient ischemic attack in patients with PFO. Our aim is to detect sensitivity and specificity of contrast-enhanced TCD in detection of RLS among stroke patients with patent foramen ovale (PFO) in comparison to TEE. Methods TEE and contrast-enhanced TCD for cryptogenic stroke patients with PFO were done to detect right to left shunting. Results On testing characteristics of TCD in detecting RLS compared to the gold standard of TEE, TCD sensitivity was 85.7%, specificity was 100%, negative predictive value was 96.55%, and positive predictive value was 100%. Conclusion We concluded that PFO is considered an important hidden etiology for ischemic stroke. Contrast-enhanced TCD is considered sensitive method for detection of right to left shunting among PFO patients.

scholarly journals Patent Foramen Ovale Closure: State of the Art

2020 ◽  
Vol 15 ◽  
Author(s):  
Joel P Giblett ◽  
Lynne K Williams ◽  
Stephen Kyranis ◽  
Leonard M Shapiro ◽  
Patrick A Calvert
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Recurrent Stroke ◽  
Adult Population ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Arterial Circulation ◽  
Arterial Embolisation ◽  
Randomised Control Trials ◽  
Paradoxical Embolus

Patent foramen ovale (PFO) is a common abnormality affecting between 20% and 34% of the adult population. For most people, it is a benign finding; however, in some people, the PFO can open widely to enable paradoxical embolus to transit from the venous to arterial circulation, which is associated with stroke and systemic embolisation. Percutaneous closure of the PFO in patients with cryptogenic stroke has been undertaken for a number of years, and a number of purpose-specific septal occluders have been marketed. Recent randomised control trials have demonstrated that closure of PFO in patients with cryptogenic stroke is associated with reduced rates of recurrent stroke. After a brief overview of the anatomy of a PFO, this article considers the evidence for PFO closure in cryptogenic stroke. The article also addresses other potential indications for closure, including systemic arterial embolisation, decompression sickness, platypnoea–orthodeoxia syndrome and migraine with aura. The article lays out the pre-procedural investigations and preparation for the procedure. Finally, the article gives an overview of the procedure itself, including discussion of closure devices.

scholarly journals Comparative Analysis of the Diagnostic Value of Several Methods for the Diagnosis of Patent Foramen Ovale

2020 ◽  
Author(s):  
Fangfang liu ◽  
Qingyu Kong ◽  
Xiaojun Zhang ◽  
Yan Li ◽  
Shimin Liang ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Statistical Significance ◽  
Cryptogenic Stroke ◽  
Diagnostic Value ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Foramen Ovale ◽  
Chi Square ◽  
The Right

Abstract Background: In recent years, patent foramen ovale (PFO) has been reported to be strongly associated with embolic strokes of undetermined source (ESUS), including cryptogenic stroke, transient ischemic attack (TIA), migraine, and so on.The aim of this research was to compare the sensitivity and positive predictive value of contrast transcranial Doppler (c-TCD), contrast- transthoracic echocardiography (c-TTE) versus contrast- transesophageal echocardiography (c-TEE), to find which is the best method to diagnose patent foramen ovale (PFO), provides reference for the further improvement of clinical. Methods: We investigated 161 patients who suffered from migraine, cryptogenic stroke, TIA, and cerebral infarction of unknown cause, all patients underwent the transcatheter examination, and put the results of the right heart catheterization (RHC) as the gold standard for PFO diagnosis. A chi-square test was used to compare the sensitivity and specificity between the three methods. A P value of <0.05 indicated statistical significance. Results: The present study revealed that c-TTE with the Valsalva maneuver yielded a higher sensitivity in detecting PFO-RLS, but the rate of misdetection might be higher than c-TCD. Conclusions: For the suspected patients, can examine with c-TCD first, if we get the positive results, then c-TTE and c-TEE should be taking to further confirmed. These findings may be helpful in the diagnosis of patent foramen ovale in practice.

Paradoxical cerebral embolism with patent foramen ovale and deep venous thrombosis caused by a massive myoma uteri

2013 ◽  
Vol 115 (6) ◽  
pp. 760-761 ◽  
Author(s):  
Shuta Toru ◽  
Toyonari Murata ◽  
Maya Ohara ◽  
Taro Ishiguro ◽  
Takayoshi Kobayashi
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Cerebral Embolism ◽  
Foramen Ovale ◽  
Myoma Uteri
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