Atherosclerotic disease of the aortic arch and the risk of ischemic stroke.


Prospective case-control study; TEE to measure aortic plaques. More plaque, more strokes. During bypass surgery, plaque becomes an embolus in the bloodstream. If the patient dies during surgery, the plaque may be found in the brain upon autopsy.

TitleAtherosclerotic disease of the aortic arch and the risk of ischemic stroke.
Publication TypeJournal Article
Year of Publication1994
AuthorsAmarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG
JournalThe New England journal of medicine
Date Published1994 Dec 1
KeywordsAged, Aorta, Aorta, Thoracic, Aortic Diseases, Arteriosclerosis, Brain Ischemia, Case-Control Studies, Cerebral Infarction, Confidence Intervals, Echocardiography, Transesophageal, Female, Humans, Intracranial Embolism and Thrombosis, Male, Middle Aged, Prospective Studies, Risk Factors

BACKGROUND: Atherosclerotic disease of the aortic arch has been suspected to be a potential source of cerebral emboli. We conducted a study to quantify the risk of ischemic stroke associated with atherosclerotic disease of the aortic arch.

METHODS: Using transesophageal echocardiography, we performed a prospective case-control study of the frequency and thickness of atherosclerotic plaques in the ascending aorta and proximal arch in 250 consecutive patients admitted to the hospital with ischemic stroke and 250 consecutive controls, all over the age of 60 years.

RESULTS: Atherosclerotic plaques > or = mm in thickness were found in 14.4 percent of the patients but in only 2 percent of the controls. After adjustment for atherosclerotic risk factors, the odds ratio for ischemic stroke among patients with such plaques was 9.1 (95 percent confidence interval, 3.3 to 25.2; P < 0.001). Among the 78 patients who had brain infarcts with no obvious cause, 28.2 percent had plaques > or = 4 mm in thickness, as compared with 8.1 percent of the 172 patients who had infarcts whose possible or likely causes were known (odds ratio, 4.7; 95 percent confidence interval, 2.2 to 10.1; P < 0.001). Plaques of > or = 4 mm in the aortic arch were not associated with the presence of atrial fibrillation or stenosis of the extracranial internal carotid artery. In contrast, plaques that were 1 to 3.9 mm thick were frequently associated with carotid stenosis of > or = 70 percent.

CONCLUSIONS: These results indicate a strong, independent association between atherosclerotic disease of the aortic arch and the risk of ischemic stroke. The association was particularly strong with thick plaques. Atherosclerotic disease of the aortic arch should be regarded as a risk factor for ischemic stroke and as a possible source of cerebral emboli.

Alternate JournalN. Engl. J. Med.
PubMed ID7969297
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