title: Aging, aortic arch calcification, and multiple brain infarcts are associated with aortogenic brain embolism.
abstract: BACKGROUND
  Mobile or ulcerated aortic plaques (MUAPs) on transesophageal echocardiography (TEE) can cause aortogenic brain embolism. Aortic arch calcification (AoAC) on chest X-ray represents systemic atherosclerosis. This study focused on AoAC on chest X-ray and its link with atheromatous aortic plaques (AAPs) on TEE in stroke patients. The aim of the present study was to assess the relationship between AoAC and AAPs in unexplained stroke patients.
  
  
  METHODS
  A total of 178 patients (mean age: 64 ± 15 years; 115 males) with ischemic stroke who underwent TEE were enrolled. The patients were classified based on TEE findings: (1) AAPs <4 mm; (2) AAPs ≥4 mm, and (3) MUAPs. The extent of AoAC on chest X-ray was divided into 4 grades (0-3). Clinical characteristics including AoAC were compared among the 3 groups. Multiple logistic regression analysis was performed to identify the independent factors associated with MUAPs. An original diagnostic criterion was defined as a potential indicator of MUAPs in unexplained stroke patients.
  
  
  RESULTS
  104 (58%) patients had AAPs <4 mm, 46 (26%) had AAPs ≥4 mm, and 28 (16%) had MUAPs. Older age (OR: 1.14; 95% CI: 1.06-1.24; p = 0.001), AoAC (OR: 2.35; 95% CI: 1.30-4.24; p = 0.005), and multiple infarctions in multiple vascular territories (VTs) demonstrated on diffusion-weighted imaging (DWI) (OR: 2.58; 95% CI: 1.35-4.92; p = 0.004) were independently associated with MUAPs. The CAM score was defined as consisting of the degree of AoAC (0-3 points), age (≥70 years: 1 point), and DWI findings (multiple infarctions in 1 VT: 1 point; 2 VTs: 2 points; more than 3 VTs: 3 points). The prevalence of MUAPs was substantially increased in patients with medium risk (CAM score 3-4, OR: 7.68; 95% CI: 2.89-20.44; p < 0.001) and high risk (CAM score 5-7, OR: 20.63; 95% CI: 5.12-83.06; p < 0.001).
  
  
  CONCLUSIONS
  Older age, advanced AoAC, and multiple infarctions in multiple VTs are associated with aortogenic brain embolism. The CAM score can be useful for the diagnosis of aortogenic brain embolism.
authors.affiliation: Department of Neurology, School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shimada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Ayami
authors.initials: A
authors.lastname: Okuzumi
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Miyamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamashiro
authors.forename: Ryota
authors.initials: R
authors.lastname: Tanaka
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001018:Aortic Diseases / Q000150:complications*; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology*; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging