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Advanced atherosclerosis of the aortic arch is uncommon in ischemic stroke: an autopsy study
Tadeusz Mendel1, Jerzy Popow, Daniel B Hier
1Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland. mendel@ipin.edu.pl
Insights
Aortic atherosclerosis was infrequent in the aortic arch but common elsewhere, while carotid atherosclerosis was more prevalent in ischemic stroke patients. These findings suggest aortic arch disease is not a primary stroke mechanism.
Area of Science:
- Cardiovascular pathology
- Neurology
- Vascular disease
Background:
- Atherosclerosis in the aorta and carotid arteries is a recognized risk factor for stroke.
- Understanding the distribution of atherosclerotic lesions is crucial for stroke etiology and prevention.
Purpose of the Study:
- To quantify the frequency of atherosclerotic lesions in the aorta and carotid arteries in stroke decedents.
- To investigate the association between aortic atherosclerosis and specific ischemic stroke subtypes.
- To determine if carotid atherosclerosis differs between stroke types.
Main Methods:
- Autopsy analysis of 207 stroke patients (1993-1997).
- Assessment of atherosclerotic lesion frequency in the aortic arch, thoracic aorta, abdominal aorta, and carotid arteries.
- Correlation of lesion presence with stroke type (ischemic vs. hemorrhagic) and ischemic stroke subtype.
Main Results:
- Advanced atherosclerotic lesions were rare in the aortic arch (1.9%) but common in the thoracic aorta (51.7%), abdominal aorta (60.4%), and carotid arteries (23.7%).
- Moderate aortic arch atherosclerosis was more frequent in ischemic stroke (75.2%) than hemorrhagic stroke (56.1%).
- Advanced carotid atherosclerosis was more prevalent in ischemic stroke (28.4%) compared to hemorrhagic stroke (13.6%) and particularly common in atherothrombotic stroke (51.4%).
Conclusions:
- The low frequency of advanced aortic arch atherosclerosis indicates it's not a common stroke mechanism.
- Carotid atherosclerosis is significantly associated with ischemic stroke, especially atherothrombotic subtypes.
- Findings highlight the importance of carotid arteries over the aortic arch in the pathogenesis of certain stroke types.
Abstract:
Aortic and carotid atherosclerosis are known risk factors for stroke. The aim of the study was to determine the frequency of atherosclerotic lesions in the aorta and carotid arteries in subjects dying of ischemic and hemorrhagic stroke and to determine whether aortic atherosclerosis was associated with any specific ischemic stroke subtype. Autopsies were performed in 207 patients who died during hospitalization for stroke from 1993 to 1997. Subjects ranged in age from 37 to 98 years, mean 74.45 years (SD +/- 11.84). There were 132 women and 75 men. Stroke was hemorrhagic in 66 and ischemic in 141. Advanced atherosclerotic lesions were less frequent in the aortic arch (1.9%) than in the thoracic aorta (51.7%), abdominal aorta (60.4%), or carotid arteries (23.7%). Moderate atherosclerotic lesions in the aortic arch were observed more frequently in ischemic (75.2%) than hemorrhagic stroke (56.1%, p=0.026). Advanced or moderate atherosclerotic lesions in any part of the aorta did not predict ischemic stroke subtype. Advanced atherosclerosis of the carotids was more common in ischemic stroke (28.4%) than hemorrhagic stroke (13.6%, p < 0.05). Advanced atherosclerosis of the carotids was more common in stroke due to atherothrombosis (51.4%) than in stroke due to cardiac embolism (22.1%) or stroke of unknown etiology (5.6%). The low frequency of advanced atherosclerotic lesions of the aortic arch suggests that this disease process is not a common mechanism of stroke.