title: Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: a multiplane transesophageal echocardiographic study.
abstract: Atherosclerotic plaque ulcers > or = 2 mm in depth and width in the thoracic aorta have been implicated by autopsy study as a cause of unexplained or cryptogenic ischemic strokes. Transesophageal echocardiography (TEE) allows visualization of complex atherosclerotic lesions of the thoracic aorta. We compared the prevalence of thoracic aorta ulcerated plaques (ulcers > or = 2 mm in both depth and width) in three age-matched groups undergoing multiplane TEE: group 1, 23 patients with cryptogenic ischemic stroke; group 2, 26 patients with known-cause strokes; and group 3, 57 control patients without strokes. TEEs were interpreted in a blinded fashion. Ulcerated plaques were found in 9 (39%) group 1 patients but in only 2 (8%) group 2 patients and in only 4 (7%) group 3 patients (p < 0.001). There was an association between advancing age and the presence of ulcerated plaques (p < 0.02). We conclude that ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic ischemic stroke and should be considered a potential source of cerebral emboli.
authors.affiliation: Department of Medicine, University of Maryland Hospital, Baltimore 21201-1595, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Stone
authors.forename: M W
authors.initials: MW
authors.lastname: Hawke
authors.forename: M
authors.initials: M
authors.lastname: LaMonte
authors.forename: S J
authors.initials: SJ
authors.lastname: Kittner
authors.forename: J
authors.initials: J
authors.lastname: Acosta
authors.forename: M
authors.initials: M
authors.lastname: Corretti
authors.forename: C
authors.initials: C
authors.lastname: Sample
authors.forename: T R
authors.initials: TR
authors.lastname: Price
authors.forename: G D
authors.initials: GD
authors.lastname: Plotnick
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014456:Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D018616:Ultrasonography, Doppler, Duplex