Background and Purpose
We aimed to investigate the incidence of May-Thurner syndrome (MTS) in cryptogenic stroke patients with patent foramen ovale (PFO).
This was a retrospective study. All consecutive patients with cryptogenic stroke having undergone PFO closure from January 1st 2002 to December 31st 2007 at our institute were included in this study. Pelvic magnetic resonance venography (MRV) studies of all patients were reviewed to determine if features of MTS were present. Medical records and invasive venography studies of all patients were reviewed when available. All patients with MTS features on MRV were reviewed by a vascular medicine specialist to define any previous incidence of DVT or any signs of chronic venous insufficiency. All patients also had lower limb venous duplex performed to rule out lower limb venous thrombosis.
A total of 470 patients from January 1 2002 until Dec 31 2007 with cryptogenic stroke underwent PFO closure at our institute. Thirty patients (6.3%) had features consistent with MTS on MRV. These patients were predominantly female (80%) with a mean age of 43.6 ± 11.9 years. Twelve patients (40%) had abnormalities in their laboratory thrombophilia evaluation and 13 females (54.1%) were taking hormone related birth control pills. Only two patients had a history and signs of chronic venous insuffiency. All PFOs demonstrated right-to-left shunting on transesophageal echocardiography. Atrial septal aneurysms/hypermobile atrial septa were present in 70% of patients with MTS.
May-Thurner syndrome has an important clinical association with cryptogenic stroke and PFO.