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[Complex aortic atheroma plaques: study of 71 patients with lacunar infarcts]

Adrià Arboix1, Maria Rexach, Marta Subirà

  • 1Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, España. aarboix@hscor.com

Medicina Clinica
|December 30, 2011
PubMed

Insights

Complex aortic atheroma plaques (CAA) were found in 18.3% of patients experiencing their first lacunar infarct (LI). These findings suggest CAA should be considered in patients with lacunar infarcts of uncertain cause.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Lacunar infarcts (LI) are small strokes often attributed to small vessel disease.
  • The role of aortic atheroma plaques as a source of embolism in LI is not fully understood.
  • Complex aortic atheroma plaques (CAA) represent a potential, yet often overlooked, embolic source.

Purpose of the Study:

  • To determine the frequency of complex aortic atheroma plaques (CAA) in patients presenting with a first-ever lacunar infarct (LI).
  • To identify clinical factors and risk factors associated with CAA in this patient population.
  • To assess the potential embolic significance of CAA in the context of lacunar stroke.

Main Methods:

  • A cohort of 71 consecutive patients with a first lacunar infarct was studied over 4 years.
  • Neuroimaging and suprasternal transthoracic echocardiography with harmonic imaging were utilized.
  • Analysis included risk factors, clinical presentation, and prognosis.

Main Results:

  • Echocardiography revealed abnormalities in 28.2% of patients.
  • Complex aortic atheroma plaques (CAA) were identified in 18.3% of patients; simple plaques were found in 9.9%.
  • Common risk factors included hypertension (69%), prior transient ischemic attack (39%), and diabetes (31%). Pure motor hemiparesis was the most frequent clinical syndrome (39%).

Conclusions:

  • Complex aortic atheroma plaques (CAA) are present in a significant proportion (18.3%) of patients with a first lacunar infarct (LI).
  • A high risk for aortic embolism was noted in 4.2% of LI patients.
  • The study recommends ruling out CAA in patients with essential lacunar infarcts, particularly those with embolic risk factors.
Abstract

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