Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke (original) (raw)
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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 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...
Journal of Neuroimaging, 2004
Objective. To identify the prevalence and characteristics of aortic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events. Background. Aortic atheroma is associated with ischemic stroke. Its characteristics, including morphology and distribution among different stroke subtypes, are not well described. Method. From July 2000 to August 2001, all patients evaluated by transesophageal echocardiography (TEE) with diagnoses of transient ischemic attacks (TIAs) and strokes were prospectively studied. Demographics, including age, gender, ethnicity, cerebrovascular risk factors, and stroke subtypes, were collected. Results. Thoracic aortic atheromas (TAAs) were present in 141 of 237 patients (59%) (mean age = 59 ± 14, 119 [50%] male). Mild plaque (<2 mm) was present in 13 of 237 (5%), moderate plaque (2-4 mm) in 49 (21%), severe plaque (≥4 mm) in 79 (33%), and complex plaque in 64 (27%). Patients' ages (odds ratio [OR] = 1.05, confidence interval [CI] 1.03-1.08, P < .001), coronary artery disease (OR = 2.2, CI 1.02-4.8, P < .042), and patent foramen ovale (PFO) (OR = 0.39, CI 0.22-0.70, P < .002) were associated with the severity and complexity of aortic plaque. In multivariate analysis, age (OR = 1.06, CI 1.03-1.08, P < .001) and the presence of PFO (OR = 0.35, CI 0.18-0.65, P < .001) continued to be significant to the severity and complexity of aortic atheroma. Gender, history of stroke, hypertension, diabetes mellitus, hyperlipidemia, and history of smoking were not associated with TAA. Conclusion. One third of TAA plaques are severe and complex in nature and more frequently present in the descending aorta and the arch of the aorta than in the ascending aorta. TEE should be considered for the early detection and treatment of TAA in patients without identified causes of stroke.
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...
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.
Background: Significant aortic arcliatheromas (>4mm thick) have been identified as one of the most powerflil independent risk factors for ischemic strokes in western patients >60 years of age, but there is little published literature on frequency of aortic atheromas in Indian population. Material and Methods: The current study was aimed at assessing the frequency and risk factors of significant aortic arch atheroma in stroke patients attending a tertiary care center in south India, whose stroke mechanism was not clear even after detailed clinical assessment, and investigations including Carotid Doppler, Magnetic resonance imaging and 2D Transthoracic echocardiography. Results: Out of 297 consecutive patients of ischemic stroke, seen between 1st January 2001 and 31st December 2001, Transesophageal Echocardiography (TEE) was performed in 85 patients with stroke of unknown mechanism. Eighteen patients (21%) were discovered to have significant and complex aortic arch atherosclerosis as the underlying cause of their stroke. The men: women ratio was 15:3 and the mean age was 54.28±12.41. Four were protruding but immobile, whereas 14 were mobile atheromas. Two patients had superadded ulcerations. Nine (50%) had hypertension, 6 (33%) had diabetes, 4 (22%) had history of smoking and 1 (5%) had alcoholism. There was no significant difference between the frequency of these risk factors between aorto-embolic and other stroke subtypes. Regarding the clinical features, 6 patients had left hemiparesis, 6 had right hemiparesis, 2 had ataxia, 2 had dementia and 1 had hemianopia. Conclusions: To conclude, aortic arch atherosclerosis was found to contribute to a significant number of stroke patients in a south Indian tertiary care center. All stroke patients with unknown mechanism should be subjected to TEE to detect aortic atheroma as this has therapeutic implications.
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.