Atherosclerotic aortic arch plaques in cryptogenic stroke: a microembolic signal monitoring study.
OBJECTIVE
To find out the prevalence of relevant atherosclerotic plaques in the aortic arch and their potential role as a source of embolism in cryptogenic stroke.


METHODS
We performed a transoesophageal echocardiography (TEE) on 49 patients with cryptogenic stroke from a total series of 212 non-selected patients with acute ischaemic stroke studied prospectively by cranial computed tomography (CT), colour-duplex and transcranial Doppler (TCD) sonography with micro-embolic signal (MES) monitoring. Cryptogenic stroke was diagnosed in those patients without carotid or intracranial stenosis > 50%, nor lacunar or cardio-embolic strokes. We defined relevant plaques as those > or = 4 mm thick located in the ascending aorta or proximal arch.


RESULTS
Twenty-three patients (46.9%) had atherosclerotic aortic plaques (AAP): 3 in the ascending aorta (in 1 > or = 4 mm), 11 in the proximal aortic arch (in 4 > or = 4 mm) and 9 in the descending aorta (in 5 > or = 4 mm). Hence, 5 patients (10.2%) had relevant plaques. Aortic plaques were significantly related to older age (p < 0.001) and male gender (p = 0.042). A carotid artery stenosis < 50% was found in 39% of patients with AAP and in 8% of those without AAP (p = 0.009). MES were detected in 3 patients with plaques > or = 4 mm thick, but not in those without AAP or with AAP < 4 mm thick (p = 0.006).


CONCLUSIONS
Although few patients with cryptogenic stroke had relevant plaques in our non-selected population, our results support the hypothesis that relevant aortic plaques have embolic potential.
Castellanos
M
M
Section of Neurology, Hospital Universitari Doctor Josep Trueta, Girona, Spain. mcastellanosr@medynet.com
Serena
J
J
Segura
T
T
Pérez-Ayuso
M J
MJ
Silva
Y
Y
Dávalos
A
A
D000368:Aged; D001015:Aortic Arch Syndromes / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D001161:Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*