title: Aortic arch atheroma in transient ischemic attack patients.
abstract: OBJECTIVE
  Aortic arch atheroma (AAA) is associated with vascular risk factors and with stroke risk. Its prevalence and prognosis remain to be defined in patients with transient ischemic attack (TIA).
  
  
  METHODS
  Using data from the SOS-TIA registry, we assessed the prevalence of AAA detected by transesophageal echocardiography (TEE). AAA was graded as moderate (<4 mm) or severe (≥4 mm). All patients had a standardized work-up investigation and were followed for 1 year.
  
  
  RESULTS
  Between January 2003 and December 2008, 1850 patients with definite/possible TIA or minor stroke were enrolled and 1231 (67%) underwent TEE. Moderate AAA was found in 26% of patients (n = 324) and severe AAA in 14% (n = 171), giving an overall AAA prevalence of 40%. Among the 873 patients without identified cause of TIA, the prevalence of moderate and severe AAA were 24% and 12% respectively. Intracranial or extracranial stenosis ≥50% were detected in 21% of patients and were independently associated with AAA (adjusted odds ratio, 1.65, 95% confidence interval (CI), 1.23-2.22). At one-year, incidence of recurrent vascular events was 2.2% in patients without AAA, 4.1% in moderate AAA and 6.6% in severe AAA (log-rank, p for trend = 0.003). Using patients without AAA as reference, and after adjustment on vascular risk factors, the hazard ratio (95% CI) for moderate was 1.36 (0.62-2.99) and 2.08 (0.89-4.86) for severe (p for trend = 0.095).
  
  
  CONCLUSIONS
  These findings support a systematic identification of AAA in TIA patients to optimize risk stratification in this specific population.
authors.affiliation: Department of Neurology and Stroke Centre, Bichat University Hospital, INSERM U-698 and Paris-Diderot University, Paris, France. Electronic address: celine.guidoux@bch.aphp.fr.
authors.forename: Céline
authors.initials: C
authors.lastname: Guidoux
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Philippa
authors.initials: P
authors.lastname: Lavallée
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Brigitte
authors.initials: B
authors.lastname: Escoubet
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology
keywords: Aorta; Atherosclerosis; Plaque; Stroke