Distribution, severity and risk factors for aortic atherosclerosis in cerebral ischemia.
Significant thoracic aortic plaques (>4 mm) are an independent risk factor for ischemic stroke. Within 1 week of stroke/transient ischemic attack (TIA) onset, 105 consecutive patients underwent transesophageal echocardiography assessment of aortic plaque thickness using the criteria of Amarenco et al. (N Engl J Med 1994;331:1474-1479). A proximo-distal gradient was found in the distribution of aortic atheroma >4 mm (p = 0.04). Symptomatic coronary artery disease was associated with plaque in the proximal aorta (p = 0.03); extracranial carotid stenosis >70% was associated with plaque in the arch and descending aorta (p < 0.01). The severity of aortic plaque was associated with age on multivariable analysis (p = 0.0003 to p < 0.01). Only smoking showed predictive regional specificity (p = 0.03);no other risk factors were associated with aortic atheroma in any segment. In stroke/TIA patients, carotid stenosis >70% predicts aortic arch atheroma plaques >4 mm which may predispose to reinfarction after endarterectomy. Atheroma of the ascending aorta is associated with ischemic heart disease, and cardiac screening should be considered in asymptomatic patients.
Sen
S
S
Cerebrovascular Program, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Md., USA.
Wu
K
K
McNamara
R
R
Lima
J
J
Piantadosi
S
S
Oppenheimer
S M
SM
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000503:physiopathology*