[Role of complex aortic atheroma plaques in the recurrence of unexplained cerebral infarction]

In a subgroup of patients with cerebral infarction, noninvasive diagnostic explorations fail to disclose the etiology. We studied the clinical course and the usefulness of transesophageal echocardiography to diagnose complex aortic atheroma plaques in patients with cerebral infarction of uncertain cause with recurrence of ischemia.

In a study population of 1840 consecutive patients with a first cerebral infarction evaluated with a screening protocol for transesophageal echocardiography, the etiology remained uncertain in 248 cases. These patients were followed during 1 year of treatment with antiplatelet agents, and transesophageal echocardiography was done if cerebral ischemia recurred. We compared the prevalence of complex aortic atheroma plaques in patients with recurrence and in patients with cerebral infarction of unknown etiology in the French Study of Aortic Plaques in Stroke, in whom there was no recurrence of cerebral infarction.

Recurrent cerebral infarction was documented in 17 of our 248 patients with infarction of unknown etiology (6.9%). Transesophageal echocardiography established the etiology in 15 of these patients (88.2%) with complex aortic atheroma plaques being identified in 14 cases (82.4%). In contrast, in patients with cerebral infarction of unknown etiology in the French study without recurrent cerebral infarction during the first year of follow-up, the prevalence of complex plaques was 21.1% (P<.0001).

During the first year of treatment with antiplatelet agents, most patients with cerebral infarction of unknown etiology had no recurrences. In the small subgroup with short-term recurrence, transesophageal echocardiography yielded the etiologic diagnosis in 88.2% of cases: the pathology most frequently involved was complex atherosclerotic disease of the aortic arch.