title: Aortic arch atherosclerotic lesions and the recurrence of ischemic stroke.
abstract: OBJECTIVE
  Aortic arch atherosclerotic lesions are often associated with embolic brain infarction. We investigated the relationship between stroke recurrence and the characteristics of aortic arch atherosclerotic lesions.
  
  
  METHODS
  Among 487 stroke patients who underwent transesophageal echocardiography, 283 patients with brain embolism diagnosed without significant occlusive lesions (> or =50%) in their cerebral arteries were included in this study. We measured the intima-media thickness (IMT) and evaluated the extension and mobility of the aortic arch atherosclerotic lesions. During a mean follow-up period of 3.4 years, we investigated the relationship between stroke recurrence and the various characteristics of the aortic arch atherosclerotic lesions.
  
  
  RESULTS
  An IMT > or =4.0 mm was found in 67 patients (25.3%). In 51 of these patients, the aortic lesions extended to the origin of the branches of the arch. Recurrences of cerebral ischemic events were found in 32 patients (recurrence group) and not in the other 251 (nonrecurrence group). Aortic atheroma > or =4.0 mm (41% versus 22%), aortic atheroma extending to the branches (63% versus 39%), and both (38% versus 16%) were more frequently seen in the recurrence group than in the nonrecurrence group (P<0.05, P<0.1, P<0.01, respectively). After adjustment for age and the presence of hypertension, an aortic atheroma that was > or =4.0 mm as well as extending to the branches was found to be an independent predictor of ischemic stroke recurrence (hazard ratio=2.42, P<0.05).
  
  
  CONCLUSIONS
  Stroke recurrence is associated with the severity of the atheroma (IMT > or =4.0 mm) and plaque extension to the branches.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasaka
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Otsubo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Oe
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology*; D001161:Arteriosclerosis / Q000150:complications / Q000473:pathology*; D020520:Brain Infarction / Q000209:etiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000150:complications; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology