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An update on aortic causes of ischemic stroke
O Heinzlef1, A Cohen, P Amarenco
1Department of Neurology, Saint-Antoine Hospital, Paris, France.
Insights
Atherosclerotic disease of the aortic arch is an underestimated cause of stroke, especially in older adults. Transesophageal echocardiography can effectively examine this condition, guiding future stroke prevention trials.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Atherosclerotic disease of the aortic arch is an emerging cause of embolic events, particularly moving thrombi.
- It is recognized as an independent risk factor for ischemic stroke and recurrent vascular events.
Purpose of the Study:
- To highlight the significance of aortic arch atherosclerosis as a source of stroke.
- To emphasize the utility of transesophageal echocardiography in evaluating this condition.
- To underscore the implications for patient management and clinical trial design.
Main Methods:
- Review of pathological and transesophageal echocardiographic studies.
- Analysis of atherosclerotic disease prevalence in different age groups.
- Assessment of transesophageal echocardiography's safety and tolerability in elderly patients.
Main Results:
- Aortic arch atherosclerosis is a frequent cause of cryptogenic stroke in patients over 60, particularly in their eighties.
- Transesophageal echocardiography is a safe and effective tool for examining the aortic arch, even in the elderly.
- This condition is a strong predictor of recurrent vascular events.
Conclusions:
- Aortic arch atherosclerosis is an underdiagnosed source of stroke and systemic emboli.
- Transesophageal echocardiography is crucial for identifying this risk factor.
- Randomized trials are needed to evaluate therapeutic strategies for patients with aortic arch atherosclerosis to reduce recurrent vascular events.
Abstract:
In the past few years evidence that atherosclerotic disease of the aortic arch is probably an underestimate source of emboli, particularly moving thrombi in the lumen, has accumulated. Pathological studies, and more recently transesophageal echocardiographic studies, have shown that atherosclerotic disease of the aortic arch is an independent risk factor for ischemic stroke and carries a high risk of recurrent vascular events. It could account for a more or less part of brain infarcts of unknown cause, with no carotid or cardiac source of emboli. This location of atherosclerotic disease is rare under 60 years of age. It mainly involves patients older than 60 years of age, and is frequent in patients in their eighties. Transesophageal echocardiography is accurate, safe and well tolerated for the examination of the aortic arch, even in elderly patients. Practical implications for patients and future clinical trials are important. As it is a strong marker for recurrent vascular events, the risks and benefits of different therapeutic options should now be evaluated in randomised trials.