Abstract TP224: Comparing Utility Of Computed Tomography Angiography Of Neck Vs Transesophageal Echocardiography For Detection Of Aortic Plaque.

Abstract

Background: Aortic arch atherosclerotic plaques of >4mm thickness, evaluated by a transesophageal echocardiogram (TEE) correlate with embolic ischemic stroke. Computed tomography angiography (CTA) of the neck, routinely done during stroke evaluation, is an alternative for the evaluation of aortic arch plaque. We hypothesized that CTA evaluation of the aortic arch plaque is comparable to TEE. Methods: We prospectively measured thickness, extent through different parts of the aortic arch (ascending, arch, and descending aorta), location of the maximal plaque thickness, calcification, mobility, and presence of thrombus in the aortic arch plaque on CTA neck and TEE exams in non-consecutive stroke patients from the hospital database. All measurements were done independently by 2 radiologists for the CTA of neck and 2 cardiologists for TEE. Paired t-test was used for mean difference and Wilcoxon signed-rank test for median difference between TEE and CTA. Results: Of 63 patients who had both CTA and TEE, 31 (mean age ± SD; 54 ± 14.46 years) were included in this analysis; as in 32 patients, aortic arch was not included on the CTA neck. Although maximal plaque thickness was comparable for both methods (CTA 3.0 ± 1.10 vs TEE 3.18 ± 2.54, p=0.68), CTA more commonly showed the extent of the plaque throughout all areas (ascending, arch, and descending) of the aorta (CTA: 25/31 vs TEE: 15/31, p<0.01), thickest plaque on the stroke embologenic (ascending and arch) location (CTA: 15/31 vs TEE: 6/31, p<0.01), and identified calcified plaque components (CTA: 26/31 vs TEE: 15/31, p<0.01). In addition, CTA exhibited branching patterns of the aorta, while TEE was beneficial to detect mobile plaque debris (8/31) and thrombi (TEE: 1/31 vs CTA: 0/31, p=1.0). Conclusion: Both CTA and TEE are useful for aortic arch evaluation in stroke patients, contributing different information. Future investigations in a larger prospective cohort are warranted.