1. Incidence of May-Thurner Syndrome in Patients undergoing Patent Foramen Ovale Closure for Cryptogenic Stroke Thomas J. Kiernan MD, Bryan P Yan MD, Pablo Rengifo-Morena MD, Vishal Gupta MD, Jonathan Eisenberg, Joseph Garasic MD, Michael Jaff DO, Ignacio Inglessis MD, Igor Palacios MD, Robert Schainfeld DO, Kenneth Rosenfield MD. Department of Vascular Medicine and Interventional Cardiology, Massachusetts General Hospital, Boston, MA
Figure 1 May-thurner syndrome: Right common iliac artery (black arrow) compresses the left common iliac vein (white arrow).
TABLE 1. Baseline Characteristics of Patients with May-thurner syndrome undergoing PFO closure in context of cyptogenic stroke.
Background:
Deep venous thrombosis associated with May-Thurner syndrome (iliac vein compression) is a potential source of paradoxical emboli in patients with a patent foramen ovale (PFO). The incidence of May-Thurner Syndrome (MTS) in patients with cryptogenic stroke and PFO is unknown.
Methods:
We performed a retrospective analysis of consecutive patients with cryptogenic stroke undergoing PFO closure from 2002 to 2007 at our institution. Magnetic resonance venography (MRV) studies of the lower limb veins were performed in all patients to assess the presence of MTS.
Results: A total of 470 patients with cryptogenic stroke underwent PFO closure. Nineteen patients (4.0%) had features consistent with MTS on MRV. These patients were predominantly female (88%) with a mean age of 40±12 years. The group represented a low cardiovascular risk group with hypertension (11%), hypercholesterolemia (11%), smokers (27%) and diabetes (16%). All PFOs demonstrated right-to-left shunting on transesophageal echocardiography. Atrial septal aneurysms were present in 16% and hypermobile atrial septae in 17% of patients. Three of 19 (16%) patients with MTS underwent percutaneous stenting of left iliac vein using self-expanding stents with a mean length of 64±12mm and mean diameter of 15.2±3.2mm. There was no recurrent stroke in patients with MTS at mean clinical follow-up of 42±6 months. All stents were patent at mean follow-up of 240±110 days on duplex ultrasonography.
Conclusion:
The incidence of May-Thurner syndrome in patients with cryptogenic stroke undergoing PFO closure was 4%.
Iliac vein stenting for May-Thurner syndrome is safe and feasible.
Recurrent stroke post PFO closure is low in patients with May-Thurner syndrome.
Variables
n=14
Age (yrs)
Women
Smokers (current)
Diabetes Mellitus
Systemic hypertension
Hyperlipidemia
Atrial septal aneurysms
Hypermobile atrial septae
40±12
17 (88%)
5 (27%)
3 (16%)
2 (12%)
Figure 2 Venogram of May-thurner syndroeme showing the compressed left common iliac vein (black arrow) and contralateral venous drainage via pelvic venous collaterals (white arrows).
Table 2.Endovascular intervention in patients with MTS after PFO closure
No of patients (16%)
Mean stent length ±12mm
Mean stent diameter ±3.2mm
Duplex follow-up (240±110 days) 100% stents patent