Atheromatous Plaques at the Origin of the Left Subclavian Artery in Patients with Ischemic Stroke

Abstract

Background: Atheromatous plaques of the aortic arch that extend to the origin of its branches may cause stroke. The frequency and clinical implications of plaque at the origin of the left subclavian artery (LSCA) in patients with recent ischemic stroke were investigated. Methods: We studied 347 consecutive patients (223 men, 69 ± 12 years) who developed symptomatic ischemic stroke and underwent transesophageal echocardiography (TEE). Results: The origin of the LSCA was identified in 303 of 347 patients (87.3%). Plaque ≧1.0 mm was detected in 108 of the 303 patients (35.6%), ranging between 1.0 and 6.1 mm (median, 2.5 mm). Patients having thicker plaque (≧2.5 mm) were older (p = 0.012) and more commonly took antiplatelets prior to stroke (p = 0.038) than patients with no plaque and those with thinner plaque (<2.5 mm). Of the aortic arch findings detected on TEE, maximum intima-media thickness (IMT) was the highest (p < 0.001) in patients with thicker plaque, and large plaque (≧4.0 mm) (p = 0.017), ulcerative plaques (p < 0.001), and spontaneous echo contrasts (p = 0.001) were identified most commonly in patients with thicker plaque. The frequency of infarcts involving the posterior circulation was similar among the three groups. After multivariate adjustment, maximum IMT of the aortic arch was independently related to thicker plaque at the LSCA origin (OR = 1.24, 95% CI = 1.03–1.51, p = 0.024, per 1-mm increase). Conclusions: Atheromatous plaque at the origin of the LSCA was present in approximately one third of patients with a recent ischemic stroke. High IMT at the aortic arch was independently related to the presence of thick plaque at the LSCA origin. The present study does not support the concept that plaque at the LSCA origin may be associated with posterior circulation infarction.

The relationship between the pre‐admission CHA2DS2‐VASc score and proximal artery occlusion in patients with acute stroke and atrial fibrillation

“…Of these, 162 patients were excluded due to an incomplete MRI study (42); the index stroke lying at a site outside the MCA territory (23); pre-stroke anticoagulant therapy (93); or concomitant etiology other than AF (4). Finally, 213 patients [102 women; median age 80 (IQR 71-86) years; NIHSS score 16 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)] were enrolled in the present study. Of these 213 patients, 56 (26%) had PAO on initial MRA performed a median of 2.1 (1.4-4.4) h after stroke onset, 32 had ICA occlusion and 24 had proximal M1 occlusion.…”

“…However, aortic plaque was not assessed as a component of the score, because transesophageal echocardiography (TEE) was performed for 83 of 213 (39%) patients in this study. The relatively high rate of performing TEE was due to our policy of checking for intracardiac thrombi, minor cardiac abnormalities and aortic atheromas as much as possible; some TEE studies were performed based on this policy . The index stroke was not counted for ‘history of ischaemic stroke’.…”

C1q/TNF‐related protein 9: A novel therapeutic target in ischemic stroke?

“…The relationship between atherosclerotic plaques stability and ischemic stroke has always been the focus of clinical researches. The plaques, locating in intracranial artery (Kim et al, ) carotid artery (Fisher, ), subclavian artery (Kuwashiro et al, ) and aorta (Katsanos et al, ), were closely related to ischemic stroke, respectively. Up to now, circulating leukocytes (Li, Bai et al, ), thyroid function (Liu, Cui et al, ), dyslipidemia (Mi et al, ), plaque elastin content (Asciutto et al, ) and MMP‐9 activity (Loftus et al, ) have been proved being likely involved in pathogenesis of atherosclerotic plaques induced ischemic stroke.…”

Comprehensive Evaluation of Coronary Artery Disease and Aortic Atherosclerosis in Acute Ischemic Stroke Patients: Usefulness Based on Framingham Risk Score and Stroke Subtype

“…Aortic atherosclerosis has been recently highlighted as a potential embolic source in patients with cryptogenic stroke [5,6,7,8]. Owing to the development of CT technology, multidetector CT has been developed to evaluate CAD, aortic atherosclerosis and other structural heart diseases [9,10,11,12,13].…”