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Retrograde embolism from the descending aorta: visualization by multidirectional 3D velocity mapping in cryptogenic
Andreas Harloff1, Christoph Strecker, Patrick Dudler
1Department of Neurology and Clinical Neurophysiology, University Hospital Freiburg, Freiburg, Germany. andreas.harloff@uniklinik-freiburg.de
Insights
Complex plaques in the descending aorta (DAo) can cause stroke. New MRI techniques reveal retrograde blood flow from these DAo plaques, identifying a previously unknown stroke mechanism.
Area of Science:
- Cardiovascular Imaging
- Neurology
- Vascular Medicine
Background:
- Complex plaques (≥4 mm) and thrombi in the descending aorta (DAo) are potential sources of embolism.
- The embolic potential of DAo plaques as a stroke source remains incompletely understood.
Purpose of the Study:
- To determine the role of complex plaques in the descending aorta (DAo) as an embolic source for stroke.
- To investigate the relationship between DAo plaque characteristics and stroke etiology.
Main Methods:
- Prospective assessment of brain ischemia territory and embolic pattern in 63 acute stroke patients undergoing TEE.
- Multidirectional 3D MRI velocity mapping of the aorta to correlate retrograde diastolic blood flow with plaque distance from the left subclavian artery (LSA).
Main Results:
- Complex DAo plaques were found in 33 of 63 patients.
- Retrograde flow connected complex DAo plaques with the LSA in 20 patients (31.7%).
- Four patients experienced embolic strokes in posterior circulation territories, unexplained by other causes, linked to this retrograde flow.
Conclusions:
- Multidirectional 3D MRI velocity mapping detected significant diastolic retrograde flow from complex DAo plaques.
- This retrograde flow represents a previously undemonstrable stroke mechanism originating from the descending aorta.
Background And Purpose:
The purpose of this study was to determine the role of plaques >or=4 mm and thrombi (complex plaques) in the descending aorta (DAo) as an embolic high-risk source for stroke.
Methods:
In 63 acute stroke patients scheduled for TEE, territory and embolic pattern of brain ischemia were prospectively assessed. Multidirectional 3D MRI velocity mapping of the aorta was performed to correlate the extent of retrograde diastolic blood flow with the distance of complex DAo plaques from the left subclavian artery (LSA). Embolic risk from the DAo was present for (1) retrograde flow connecting complex DAo plaques with the LSA, (2) embolic pattern of brain ischemia in a territory supplied by the left vertebral artery, and (3) stroke that could not be explained by other means.
Results:
33 of 63 patients had complex DAo plaques (distance to LSA 28.1+/-29.9 mm). Mean retrograde flow in these subjects was 26.2+/-12.3 mm. In 20 of 63 patients (31.7%) retrograde flow connected complex DAo plaques with the LSA. In 4 of these 20 patients (20%) with an embolic stroke in the territory of the brain stem, cerebellum or posterior cerebral artery, etiology could not be explained by other means.
Conclusions:
Substantial diastolic retrograde flow originating from complex plaques in the descending aorta was detected by multidirectional 3D MRI velocity mapping and constitutes a stroke mechanism that was previously not demonstrable.
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