Risk of stroke in patients with mitral annulus calcification

63 patients with mitral annulus calcification (MAC) were followed for an average of 3.4 years. Two patients experienced TIA, both ipsilateral to a previous endarterectomy site, and IV-DSA demonstrated normal extracranial vessels. There were 3 strokes (5%), all fatal, but none could be attributed to embolism. Embolic stroke due to MAC is rare and difficult to prove due to coexistent atherosclerosis. Associated cardiac conditions such as atrial fibrillation, which might increase the risk of embolism, usually occur with MAC greater than or equal to 5 mm. In many patients, MAC may be better viewed as a marker of generalized calcific atherosclerosis rather than as an immediate embolic source.