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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

European Neurology
|April 18, 2001
PubMed

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.
Abstract

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