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Detecting atheromatous plaques in the aortic arch or supra-aortic arteries for more accurate stroke subtype
Xiaoyang Cui1, Simiao Wu, Quantao Zeng
11Department of Neurology, West China Hospital, Sichuan University , Chengdu , China.
Insights
Investigating aortic arch plaques in stroke patients revealed they are not correlated with carotid plaques or intracranial stenosis. However, detecting these plaques significantly reduced the undetermined etiology group, improving stroke classification.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Biology
Background:
- Atheromatous plaques in the aortic arch and supra-aortic arteries are potential sources of emboli in ischemic stroke.
- Current stroke workup often focuses on carotid and intracranial arteries, potentially overlooking sources in the proximal aorta.
Purpose of the Study:
- To investigate the correlation between atheromatous plaques in the aortic arch/supra-aortic arteries and intracranial arterial stenosis or carotid plaques in ischemic stroke patients.
- To determine if including aortic arch/supra-aortic artery evaluation reduces the proportion of stroke patients with undetermined etiology.
Main Methods:
- Prospective enrollment of 308 ischemic stroke patients.
- Comparison of clinical characteristics and Atherosclerosis, Small-vessel disease, Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, and Other (A-S-C-O) classifications.
- Analysis included intracranial arteries, carotid arteries, aortic arch, and supra-aortic arteries.
Main Results:
- Plaques in the aortic arch or supra-aortic arteries were found in 40.6% of patients, with 84.8% being complex.
- No significant correlation was observed between aortic/supra-aortic plaques and carotid plaques (p=0.283) or intracranial stenosis (p=0.097).
- Detection of mobile thrombi in the aortic arch/supra-aortic arteries increased the atherothrombosis group from 33.8% to 55.5% (p=0.00) and decreased the undetermined etiology group from 19.2% to 11.0% (p=0.00).
Conclusions:
- Evaluation limited to carotid and intracranial arteries may be insufficient for comprehensive stroke etiology assessment.
- Incorporating assessment of the aortic arch and supra-aortic arteries in stroke workup is recommended.
- This broader evaluation can lead to more accurate stroke subtype classification and guide secondary prevention strategies.
Introduction:
To investigate the correlations of atheromatous plaques in the aortic arch or supra-aortic arteries with intracranial arterial stenosis and carotid plaques in stroke patients, and to determine whether taking these plaques into account will reduce the proportion of patients in the undetermined etiology group.
Methods:
We prospectively enrolled 308 ischemic stroke patients, whose clinical characteristics and A-S-C-O classifications were compared with analyses of intracranial arteries, carotid arteries, aortic arch, and supra-aortic arteries.
Results:
125(40.6%) patients had plaques in the aortic arch or supra-aortic arteries, of which 106 (84.8%) had complex plaques. No correlations were observed between these plaques and carotid plaques ( p = 0.283) or intracranial arterial stenosis ( p = 0.097). After detecting the mobile thrombi in the aortic arch and supra-aortic arteries, the proportion of patients in the atherothrombosis group was increased from 33.8% to 55.5% ( p = 0.00), whereas the proportion of patients in stroke of undetermined etiology group was decreased from 19.2% to 11.0% ( p = 0.00).
Discussion:
Examining only the carotid and intracranial arteries may not provide adequate information about large arteries in stroke patients. Therefore, it would be better to include a search for relevant plaques in the aortic arch or supra-aortic arteries in modern stroke workup, for it may lead to more accurate stroke subtype classification and guide secondary prevention.
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