Related Experiment Videos
Aortic atheroma. An unknown source of ischemic stroke
M Accadia1, L Ascione, P F Tartaglia
1Divisione di Cardiologia con UTIC, Ospedale Loreto Mare, Naples, Italy.
Minerva Cardioangiologica
|February 7, 2002
Summary
Aortic atheroma, plaque in the aorta, is a significant source of embolic stroke, especially in cryptogenic strokes. Transesophageal echocardiography is crucial for diagnosis and risk assessment in stroke patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Cerebrovascular mortality constitutes 25% of all cardiovascular deaths.
- Approximately 25% of ischemic strokes are of unknown etiology.
- Identifying stroke mechanisms is vital for epidemiology, prognosis, and treatment.
Purpose of the Study:
- To highlight aortic atheroma as a potential embolic source in ischemic stroke.
- To review the diagnostic utility of transesophageal echocardiography for aortic atheroma.
- To discuss management strategies for aortic atheroma in stroke patients.
Main Methods:
- Transesophageal echocardiography (TEE) for aortic arch and thoracic aorta assessment.
- Review of retrospective and prospective studies on aortic atheroma prevalence and risk.
- Analysis of plaque characteristics associated with embolic events.
Main Results:
- Aortic atheroma >4 mm in the aortic arch is prevalent (15%) in stroke patients.
- Plaques =/> 4 mm in the thoracic aorta increase cardiovascular event risk (26%/year) and recurrent stroke (12%/year).
- Unstable plaques feature protrusion, thickness >4 mm, lack of calcification, and mobile thrombus.
Conclusions:
- Transesophageal echocardiography is the method of choice for studying aortic atheroma in cryptogenic stroke.
- Statins and anticoagulation show promise in managing aortic atheroma-related stroke.
- Surgical endarterectomy has limited indications due to risks.