Plaque morphology correlates with cerebrovascular symptoms in patients with complex aortic arch plaque.
BACKGROUND
Studies of aortic arch plaques with transesophageal echocardiography have demonstrated that complex aortic arch plaques (CAPs) greater than or equal to 4 mm in thickness are associated with ischemic stroke. Recent studies have demonstrated that the morphological features of plaques may aid in the identification of aortic plaques that are more likely to be associated with embolic stroke.


OBJECTIVE
To identify aortic plaques that are more likely to be associated with embolic stroke by means of their morphological features.


METHODS
Transcutaneous B-mode ultrasonography was used to image aortic arch plaques in 500 consecutive patients. The criteria used to identify the morphological features of carotid artery plaques that are more likely to be associated with ischemic stroke (heterogeneous rather than homogeneous) were applied to aortic arch plaques. Statistical comparisons were made using the Fisher exact test.


RESULTS
Ischemic symptoms (eg, stroke, transient ischemic attack, and amaurosis fugax) were present in 38% of 104 patients with CAP and in 34% of 391 patients without CAP. Nineteen (51%) of 37 patients with heterogeneous CAP were symptomatic. Twenty-one (31%) of 67 patients with homogeneous CAP were symptomatic (P = .04).


CONCLUSIONS
Transcutaneous B-mode ultrasonography of the aortic arch can help to identify heterogeneous plaques that are more likely to be associated with ischemic stroke using morphological criteria derived from studies of carotid artery plaque.
Weinberger
J
J
Department of Neurology, The Mount Sinai School of Medicine, New York, NY 10029, USA.
Papamitsakis
N
N
Newfield
A
A
Godbold
J
J
Goldman
M
M
D020757:Amaurosis Fugax / Q000000981:diagnostic imaging / Q000473:pathology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D017548:Echocardiography, Transesophageal; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D020521:Stroke / Q000000981:diagnostic imaging* / Q000473:pathology*