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Prevalence of potential retrograde embolization pathways in the proximal descending aorta in stroke patients and

Thomas Wehrum1, Miriam Kams, Christoph Strecker

  • 1Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.

Cerebrovascular Diseases (Basel, Switzerland)
|December 5, 2014
PubMed

Insights

Retrograde diastolic blood flow in the descending aorta (DAo) is common in all patients. However, complex plaques in the DAo significantly increase the risk of stroke by creating potential embolization pathways.

Area of Science:

  • Cardiovascular imaging and neurology
  • Aortic plaque analysis
  • Stroke etiology research

Background:

  • Retrograde diastolic blood flow in the descending aorta (DAo) near supra-aortic arteries may cause stroke.
  • Previous studies focused on high-risk populations with aortic atheroma.
  • This study investigates this stroke mechanism in unselected cryptogenic stroke patients and controls.

Purpose of the Study:

  • To quantify the frequency of retrograde embolization pathways in unselected cryptogenic stroke patients.
  • To compare the prevalence of these pathways in stroke patients versus controls.
  • To identify the role of complex aortic plaques in stroke etiology.

Main Methods:

  • 88 patients (67 stroke, 21 controls) underwent 3D bright blood MRI of the aorta.
  • 4D flow MRI was used to measure time-resolved 3D blood flow.
  • Retrograde embolization pathways were defined by co-occurring complex plaques and retrograde flow in the DAo.

Main Results:

  • Complex DAo plaques were more frequent in stroke patients (46.3%) than controls (19.1%).
  • Retrograde diastolic blood flow in the DAo occurred in all patients.
  • Potential retrograde embolization pathways were three times more frequent in stroke patients (32.8%) vs. controls (9.5%).

Conclusions:

  • Retrograde flow in the descending aorta is a common phenomenon.
  • Potential retrograde embolization pathways are primarily dependent on complex plaque presence.
  • The higher frequency in stroke patients suggests this mechanism contributes to retrograde brain embolism.
Abstract

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