Aortic arch atheroma and stroke recurrence in mild stroke patients: ADS post-hoc analysis

Aortic arch atheroma is one of the embolic sources in patients with ischemic stroke. Although transesophageal echocardiogram (TEE) is the golden standard to evaluate the aortic arch atheroma, it is invasive and may be limited to patients with suspected embolism. Present post-hoc analysis evaluated the acute dual study data on mild stroke patients who had aortic arch atheroma proven by TEE and evaluate whether combined cilostazol and aspirin therapy might reduce the rate of stroke recurrence comparing aspirin therapy.

Aortic arch atheroma was defined as aortic arch plaque with a maximal intima-medial thickness of ≥4.0 mm. Stroke recurrence included new diffusion-weighted image (DWI) lesions within 14 days.

Among 316 (227 [72%] men; median, 66 [interquartile, 60-76] years old) patients, TEE found that 93 patients (29%) had the aortic arch atheroma, and 223 (71%) did not had it. The aortic arch atheroma group was older (P = 0.001) and accompanied with diabetes mellitus (P = 0.003), dyslipidemia (P = 0.046), smoking (P = 0.034), and had previous ischemic stroke history (P = 0.042) and multiple infarcts (P = 0.024) on admission. During hospitalization, new DWI lesion was frequently observed in the aortic arch atheroma group compared to the group without it (14.1% vs. 6.8%, P = 0.049). The rates of new DWI lesion were not different between dual antiplatelet therapy group and aspirin group (14.9% vs. 13.3%, P = 1.000).

Aortic arch atheroma was the representative of systematic arteriosclerosis associated with new DWI lesion in short-term. Combined antiplatelet therapy using cilostazol did not prevent new DWI appearance comparing aspirin therapy in this cohort.