Supplementary Material for: Diagnostic Yield of Venous Thrombosis and Pulmonary Embolism by Combined CT Venography and Pulmonary Angiography in Patients with Cryptogenic Stroke and Patent Foramen Ovale

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 D-dimers and C reactive protein level than patients without PE-DVT (p &lt; 0.05). <b><i>Conclusion:</i></b> CVPA may be used by the stroke team in the work-up of suspected paradoxical embolism among cryptogenic ischemic stroke patients with PFO.

**<i>背景：</i>** 有研究提出，经卵圆孔未闭（patent foramen ovale, PFO）发生的反常栓塞可能是缺血性卒中的潜在发病机制。CT静脉造影联合肺动脉造影（combined CT venography and pulmonary angiography, CVPA）是一种简便、经验证且准确的深静脉血栓形成（deep venous thrombosis, DVT）或肺栓塞（pulmonary embolism, PE）诊断技术。本研究旨在通过CVPA评估合并卵圆孔未闭的隐源性卒中（cryptogenic stroke, CS）患者中深静脉血栓形成或肺栓塞的患病率。**<i>方法：</i>** 研究对象从本卒中单元收治的连续性卒中患者临床登记库中回顾性筛选。本研究纳入标准如下：确诊为隐源性卒中、经对比增强经胸超声心动图检出卵圆孔未闭，且于卒中发作后住院期间接受了CVPA检查。**<i>结果：</i>** 共有114例合并卵圆孔未闭的患者在卒中症状发作后7天内（四分位间距（interquartile range）4~9天）接受了CVPA检查。脑部影像学检查显示，11%的患者存在多发梗死灶。CVPA检出深静脉血栓形成患者10例（8.8%）、肺栓塞患者5例（4.4%），总计12例患者，总患病率为10.5%（95%置信区间（95% confidence interval, 95% CI）5.5~17.7）。合并深静脉血栓形成/肺栓塞的患者，其D-二聚体（D-dimer）与C反应蛋白（C reactive protein）水平均高于未合并该类病症的患者（p < 0.05）。**<i>结论：</i>** 卒中诊疗团队可在合并卵圆孔未闭的隐源性缺血性卒中患者中，采用CVPA开展疑似反常栓塞的相关检查评估。