Atherosclerotic Aortic Arch Plaques in Acute Ischemic Stroke

Abstract

Background: Atherosclerotic aortic arch plaques (AAP) have been linked to an increased risk of thrombo-embolic events as a
cause of acute ischemic stroke of undetermined etiology.
Objectives: To find outthe presence of atherosclerotic plaquesin aortic arch and their potential
role as a source of embolism in cerebral infarction of undetermined etiology.
Methods: We performed trans-esophageal echocardiography (TEE) and multislice
computerized tomography (MSCT) of the aortic arch on 30 patients with acute ischemic
stroke of undetermined cause from a total series of 150 non-selected patients with acute
ischemic stroke studied prospectively by clinical evaluation, laboratory investigations,
cranial computed tomography ,color coded duplex ultrasonography of the carotid arteries
and transcranial Doppler (TCD).
Results: Using trans-esophageal echocardiography eight patients(29.6%) had atherosclerotic
aortic arch plaques, while using multislice computerized tomography atherosclerotic aortic
arch plaques were revealed in twelve patients (40%). Atherosclerotic aortic arch plaques
were significantly related to older age, male gender, hypertension, ischemic heart disease and
low-grade atherosclerotic carotid lesions. Multislice computerized tomography of the aortic
arch was more sensitive than trans-esophageal echocardiography in detecting the site, size
and characters of atherosclerotic aortic arch plaques.
Conclusion: Atherosclerotic aortic arch plaques are a frequent finding in patients with acute
ischemic stroke of undetermined cause supporting the hypothesis that aortic plaques have embolic potential. In addition, multislice
computerized tomography is more sensitive than trans-esophageal echocardiography in detecting atherosclerotic aortic arch plaques
and better characterization of these plaques especially relevant one.