Population-based study of the relationship between atherosclerotic aortic debris and cerebrovascular ischemic events.
OBJECTIVE
To assess the validity of the suggestion that protruding atheromatous material in the thoracic aorta is an important cause of cerebrovascular ischemic events (CIEs) (ie, transient ischemic attack or ischemic stroke).


METHODS
This case-control study of Olmsted County, Minnesota, residents who underwent transesophageal echocardiography (TEE) from 1993 to 1997 included controls without CIE randomly selected from the population, controls without CIE referred for TEE because of cardiac disease, cases with incident CIE of obvious cause (noncryptogenic), and cases with incident CIE of uncertain cause (cryptogenic).


RESULTS
Of the 1135 subjects, 520 were randomly selected controls without CIE, 329 were controls without CIE referred for TEE, 159 were noncryptogenic CIE cases, and 127 were cryptogenic CIE cases. Complex atherosclerotic aortic debris in ascending and transverse segments of the arch was detected in 8 randomly selected controls (1.5%), 13 referred controls (4.0%), and 15 noncryptogenic (9.4%) and 4 cryptogenic (3.1%) CIE cases. After adjusting for age, sex, hypertension, smoking, atrial fibrillation, valvular heart disease, congestive heart failure, and atherosclerosis other than in the thoracic aorta, complex atherosclerotic aortic debris was not significantly associated with group status. With randomly selected controls as the referent group, odds ratios (95% confidence intervals) were 1.72 (0.61-4.87) for referred controls, 3.16 (1.18-8.51) for noncryptogenic CIE cases, and 1.39 (0.39-4.88) for cryptogenic CIE cases.


CONCLUSIONS
Complex atherosclerotic aortic debris is not a risk factor for cryptogenic ischemic stroke or transient ischemic attack but is a marker for generalized atherosclerosis and well-established atherosclerotic and cardioembolic mechanisms of cerebral ischemia. Embolization from the aorta is not a common mechanism of ischemic stroke or transient ischemic attack.
Petty
George W
GW
Division of Cerebrovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. petty.george@mayo.edu
Khandheria
Bijoy K
BK
Meissner
Irene
I
Whisnant
Jack P
JP
Rocca
Walter A
WA
Sicks
JoRean D
JD
Christianson
Teresa J H
TJ
O'Fallon
W Michael
WM
McClelland
Robyn L
RL
Wiebers
David O
DO
D000368:Aged; D001011:Aorta / Q000473:pathology*; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*