Association of aortic plaque with intracranial atherosclerosis in patients with stroke

Nam, Hyo Suk; Han, Sang Won; Lee, J. Y.; Ahn, Sang Hoon; Ha, Jong Won; Rim, Se Joong; Lee, B. I.; Heo, Ji Hoe

doi:10.1212/01.wnl.0000238511.72927.3c

Cited by 46 publications

(33 citation statements)

References 15 publications

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“…Briefly, age may be reflective of duration of exposure to vascular risk factors on plaque formation, whereas the negative association of small-vessel occlusive strokes and AA atheroma progression probably reflects a converse positive association between the non-small-vessel occlusive strokes (cardioembolism and large-artery atherothrombosis) and AA atheroma progression. Prior studies have reported an association of large-artery atherothrombois 32 and cardioembolic sources 33 with AA atheroma. Finally, complex mobile plaques are thought to represent mobile "debris" or a free-floating thrombus that might serve as a nidus for plaque activity and progression by thrombus accretion.…”

Section: Discussionmentioning

confidence: 94%

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack

et al. 2007

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Background-It is not known whether progression of aortic arch (AA) atheroma is associated with vascular events in patients with stroke or transient ischemic attack (TIA). Methods and Results-AA atheroma was detected on baseline transesophageal echocardiogram in 167 consecutive patients who had prevalent stroke or TIA. Of these, 125 consented to a follow-up transesophageal echocardiogram at 12 months. Adequate paired AA images were obtained in 117 (78 with strokes, 39 with TIAs), which allowed detailed measurements of plaques. On admission for their index stroke or TIA, patients were assessed for stroke risk factors, stroke subtypes, baseline AA plaque characteristics, and laboratory parameters. Progression of AA atheroma was observed in 33 patients (28%) on 12-month follow-up transesophageal echocardiogram. It was determined that the progression group had significantly higher adjusted homocysteine levels (PϽ0.0001) and neutrophil counts (PϽ0.0001) than the no-progression group. These patients were followed up for a median of 1.7 years from the index stroke/TIA (range 0.5 to 4.5 years) for vascular events including stroke, TIA, myocardial infarction, and death due to vascular causes. Kaplan-Meier curves showed fewer patients with AA atheroma progression remained free of the composite vascular end point (49% compared with 89% in the no-progression group; PϽ0.0001). AA atheroma progression was associated with composite vascular events (hazard ratio 5.8, 95% confidence interval 2.3 to 14.5, Pϭ0.0002) after adjustment for a propensity score based on confounders. Conclusions-In

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Section: Discussionmentioning

confidence: 94%

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack

et al. 2007

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“…Aortic atheromatous plaques are more frequently found in elders, smokers, and in patients with hypertension, diabetes mellitus, or hypercholesterolemia. 3 The presence of plaques in the aorta was found to be significantly associated with both intracranial and extracranial atherosclerosis in patients with stroke, 24 whereas plaques in the arch and descending aorta were found to be an independent predictor of >70% extracranial carotid artery stenosis in patients with stroke or transient ischemic attack. 25 Age, smoking history, and pulse pressure were independently associated with a higher frequency of atherosclerosis and complex atherosclerosis in the aorta.…”

Section: Discussionmentioning

confidence: 99%

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Katsanos

Giannopoulos

Kosmidou

et al. 2014

Stroke

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This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic Background and Purpose-Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods-We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results-We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Conclusions-Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism. (Stroke. 2014;45:1764-1770.)

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“…The correlation of coronary atherosclerosis in Korean patients, however, may be stronger for extracranial carotid atherosclerosis than LAICOD. 18 Concomitant occurrence of LAICOD and coronary atherosclerosis should not be unexpected because intracranial atherostenosis may be associated with aortic plaque 19 and metabolic syndrome, 20 factors that may be associated with coronary atherosclerosis. The GESICA natural history study based in France suggests both a high 2-year recurrence rate of ischemic events in the stenotic cerebral artery territory (38.2% with stroke accounting for 13.7% and transient ischemic attack 24.5% of events) and cardiovascular events in 18.6% with an 8.8% vascular death rate.…”

Section: Risk Of Stroke and Other Cardiovascular Disease In Large Artmentioning

confidence: 99%

Large Artery Intracranial Occlusive Disease

Gorelick

Wong

Bae

et al. 2008

Stroke

586

252

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Background and Purpose-Large artery intracranial occlusive disease (LAICOD) is a common and important stroke subtype. In this commentary, we review key epidemiological aspects of LAICOD. Summary of Review-LAICOD has emerged as the most common stroke subtype worldwide and is associated with a high risk of recurrent stroke. Hypotheses have been proposed to explain causation, which include such factors as traditional cardiovascular risk factors, high blood volume states, and genetic abnormalities. Approaches to treatment such as antithrombotic therapies, revascularization procedures, and counterpulsation devices hold promise. Conclusions-LAICOD poses a major stroke problem worldwide and is likely the most common stroke subtype. The etiology and treatment of this disorder remain poorly defined. International collaborations are needed to pool collective knowledge and develop definitive studies to better understand causation and treatment of LAICOD.

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Association of aortic plaque with intracranial atherosclerosis in patients with stroke

Cited by 46 publications

References 15 publications

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Large Artery Intracranial Occlusive Disease

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