Complex Aortic Arch Atheromas: A New Potential Source of Brain Embolism, Frequency, Risk Factors And Management (original) (raw)
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Atherosclerotic aortic arch plaques in acute ischemic stroke
Journal of vascular and interventional neurology, 2011
Atherosclerotic aortic arch plaques (AAP) have been linked to an increased risk of thrombo-embolic events as a cause of acute ischemic stroke of undetermined etiology. To find out the presence of atherosclerotic plaques in aortic arch and their potential role as a source of embolism in cerebral infarction of undetermined etiology. We performed trans-esophageal echocardiography (TEE) and multislice computerized tomography (MSCT) of the aortic arch on 30 patients with acute ischemic stroke of undetermined cause from a total series of 150 non-selected patients with acute ischemic stroke studied prospectively by clinical evaluation, laboratory investigations, cranial computed tomography, color coded duplex ultrasonography of the carotid arteries and transcranial Doppler (TCD). Using trans-esophageal echocardiography eight patients (29.6%) had atherosclerotic aortic arch plaques, while using multislice computerized tomography atherosclerotic aortic arch plaques were revealed in twelve pa...
International Journal of Cardiology and Lipidology Research, 2015
Complex atheromatosis of the aortic arch has been increasignly recognized as a cause of cerebral infarction in patients with stroke of uncertain etiology. The incorporation of transesophageal echocardiographic studies in routine clinical practice allows direct visualization of cardiac and vascular structures previously innaccessible, including atherosclerotic plaques in the aortic arch. Large atheromatous plaques, which protrude strikingly into the aortic arch lumen and have obvious mobile components are associated with a high probability of being the etiology of embolism. Aortic arch atheromatosis should be considered a dynamic process entailing a non-negligible risk of recurrent cardiovascular events. Therefore, adequate diagnosis and optimal treatment is mandatory for secondary prevention of cerebral ischemic infarction and progression of aortic arch atheromas.
Aortic atheromas in stroke subgroups detected by multidetector computed tomographic angiography
Clinical Neurology and Neurosurgery, 2009
Background: The aim of this study was to investigate aortic atheromas in stroke subgroups. Methods: Two hundred consecutive subjects had acute ischemic stroke confirmed by diffusion-weighted imaging (DWI) (195 cases) or computerized tomography (5 cases). Multidetector computed tomographic angiography (MDCTA) (16-or 64-slice) was used to detect atherosclerotic plaques in vessels. Patient data and diagnostic test results were recorded. Stroke subgroups (TOAST classification) were compared with respect to plaque features in the ascending aorta or aortic arch such as presence of at least 1 plaque, larger than 1 mm thick, multiple plaques, and plaque morphology (calcific, soft, mixed and ulcerated). Results: Of the patients, 20.3% were in the large-artery atherosclerosis (LAA), 29.4% had small artery occlusion (SAO), 23.8% had cardioembolism (CE), 6.6% had more than one potential cause found (MPC) and 19.8% had cryptogenic stroke (CS). Overall, 49.7% of patients had at least 1 plaque (any size) in the ascending aorta or aortic arch. The corresponding rates for subgroups were as follows: LAA 80%, SAO 50%, CE 44.7%, MPC 61.5% and CS 20.5% (p < 0.001). Subgroups also differed significantly with respect to presence of multiple plaques and plaques > 1 mm thick. Of all plaques 93% were mixed type, of which 19% were ulcerated. Conclusions: Almost half of the stroke cases had atheroma in ascending aorta or aortic arch and most of them had a soft component. Subgroups LAA, SAO, and MPC had higher aortic atheroma density compared to CE and CS.
Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke
Stroke, 2014
Background and Purpose— Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods— We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results— We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transes...
Aortic arch atheroma in transient ischemic attack patients
Atherosclerosis, 2013
Objective: Aortic arch atheroma (AAA) is associated with vascular risk factors and with stroke risk. Its prevalence and prognosis remain to be defined in patients with transient ischemic attack (TIA). Methods: Using data from the SOS-TIA registry, we assessed the prevalence of AAA detected by transesophageal echocardiography (TEE). AAA was graded as moderate (<4 mm) or severe (!4 mm). All patients had a standardized work-up investigation and were followed for 1 year. Results: Between January 2003 and December 2008, 1850 patients with definite/possible TIA or minor stroke were enrolled and 1231 (67%) underwent TEE. Moderate AAA was found in 26% of patients (n ¼ 324) and severe AAA in 14% (n ¼ 171), giving an overall AAA prevalence of 40%. Among the 873 patients without identified cause of TIA, the prevalence of moderate and severe AAA were 24% and 12% respectively. Intracranial or extracranial stenosis !50% were detected in 21% of patients and were independently associated with AAA (adjusted odds ratio, 1.65, 95% confidence interval (CI), 1.23e2.22). At one-year, incidence of recurrent vascular events was 2.2% in patients without AAA, 4.1% in moderate AAA and 6.6% in severe AAA (log-rank, p for trend ¼ 0.003). Using patients without AAA as reference, and after adjustment on vascular risk factors, the hazard ratio (95% CI) for moderate was 1.36 (0.62e2.99) and 2.08 (0.89e4.86) for severe (p for trend ¼ 0.095). Conclusions: These findings support a systematic identification of AAA in TIA patients to optimize risk stratification in this specific population.
Stroke; a journal of cerebral circulation, 2014
This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic Background and Purpose-Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods-We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results-We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Conclusions-Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism. (Stroke. 2014;45:1764-1770.)
Atherosclerotic Plaques in the Aortic Arch and Subclinical Cerebrovascular Disease
Stroke; a journal of cerebral circulation, 2016
Aortic arch plaque (AAP) is a risk factor for ischemic stroke, but its association with subclinical cerebrovascular disease is not established. We investigated the association between AAP and subclinical cerebrovascular disease in an elderly stroke-free community-based cohort. The CABL study (Cardiovascular Abnormalities and Brain Lesions) was designed to investigate cardiovascular predictors of silent cerebrovascular disease in the elderly. AAPs were assessed by suprasternal transthoracic echocardiography in 954 participants. Silent brain infarcts and white matter hyperintensity volume (WMHV) were assessed by brain magnetic resonance imaging. The association of AAP thickness with silent brain infarcts and WMHV was evaluated by logistic regression analysis. Mean age was 71.6±9.3 years; 63% were women. AAP was present in 658 (69%) subjects. Silent brain infarcts were detected in 138 participants (14.5%). In multivariate analysis adjusted for potential confounders, AAP thickness and l...