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Atherosclerotic aortic arch plaques in cryptogenic stroke: a microembolic signal monitoring study
M Castellanos1, J Serena, T Segura
1Section of Neurology, Hospital Universitari Doctor Josep Trueta, Girona, Spain. mcastellanosr@medynet.com
Insights
Relevant aortic plaques were found in 10.2% of patients with cryptogenic stroke. These plaques, particularly those thicker than 4mm, showed potential as a source of embolism, contributing to stroke events.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Biology
Background:
- Cryptogenic stroke remains a diagnostic challenge, often requiring investigation into less common etiological factors.
- Atherosclerotic plaques in the aorta, particularly the aortic arch, are increasingly recognized as potential sources of embolism.
Purpose of the Study:
- To determine the prevalence of relevant atherosclerotic plaques in the aortic arch.
- To investigate the embolic potential of these aortic plaques in patients experiencing cryptogenic stroke.
Main Methods:
- Transoesophageal echocardiography (TEE) was performed on 49 patients diagnosed with cryptogenic stroke.
- Patients were selected from a larger cohort of 212 acute ischemic stroke patients undergoing comprehensive stroke workup, including imaging and micro-embolic signal (MES) monitoring.
- Relevant plaques were defined as those ≥4 mm thick in the ascending aorta or proximal aortic arch.
Main Results:
- Atherosclerotic aortic plaques (AAP) were identified in 46.9% of patients, with 10.2% having relevant plaques (≥4 mm thick).
- Relevant aortic plaques were significantly associated with older age and male gender.
- Micro-embolic signals (MES) were detected in patients with plaques ≥4 mm thick, suggesting an embolic mechanism, and were absent in those without plaques or with thinner plaques.
Conclusions:
- Despite a low prevalence in this unselected population, relevant aortic plaques demonstrate embolic potential in cryptogenic stroke.
- These findings support the consideration of aortic arch atherosclerosis as a potential source of embolism in cryptogenic stroke etiology.
Background And Purpose:
To find out the prevalence of relevant atherosclerotic plaques in the aortic arch and their potential role as a source of embolism in cryptogenic stroke.
Methods:
We performed a transoesophageal echocardiography (TEE) on 49 patients with cryptogenic stroke from a total series of 212 non-selected patients with acute ischaemic stroke studied prospectively by cranial computed tomography (CT), colour-duplex and transcranial Doppler (TCD) sonography with micro-embolic signal (MES) monitoring. Cryptogenic stroke was diagnosed in those patients without carotid or intracranial stenosis > 50%, nor lacunar or cardio-embolic strokes. We defined relevant plaques as those > or = 4 mm thick located in the ascending aorta or proximal arch.
Results:
Twenty-three patients (46.9%) had atherosclerotic aortic plaques (AAP): 3 in the ascending aorta (in 1 > or = 4 mm), 11 in the proximal aortic arch (in 4 > or = 4 mm) and 9 in the descending aorta (in 5 > or = 4 mm). Hence, 5 patients (10.2%) had relevant plaques. Aortic plaques were significantly related to older age (p < 0.001) and male gender (p = 0.042). A carotid artery stenosis < 50% was found in 39% of patients with AAP and in 8% of those without AAP (p = 0.009). MES were detected in 3 patients with plaques > or = 4 mm thick, but not in those without AAP or with AAP < 4 mm thick (p = 0.006).
Conclusion:
Although few patients with cryptogenic stroke had relevant plaques in our non-selected population, our results support the hypothesis that relevant aortic plaques have embolic potential.