Coexisting of aortic arch atheroma and atrial fibrillation for short-term recurrence and poor functional outcome in acute stroke

Anan, Yuhei; Mashiko, Takafumi; Matsuzono, Kosuke; Miura, Kumiko; Ozawa, Tadashi; Suzuki, Masayuki; Ozawa, Michiko; Kameda, Tomoaki; Koide, Reiji; Tanaka, Ryota; Fujimoto, Shigeru

doi:10.1007/s10072-021-05722-0

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…The cause of strokes could not only be cardiogenic embolism due to AF but also atherogenic embolism due to complex atherosclerotic plaques. Anan et al observed that complex aortic arch atheroma was present in 39% of patients with AF 6 . These patients had significantly higher risks of stroke recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Anan et al observed that complex aortic arch atheroma was present in 39% of patients with AF. 6 These patients had significantly higher risks of stroke recurrence. In an international multicenter registry including 770 patients with AF, complex atherosclerotic plaques were identified by TEE in 25% of the cohort.…”

Section: Atherosclerotic Plaque and Stroke In Patients With Afmentioning

confidence: 99%

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3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Wen,

Naqvi

2024

Echocardiography

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Atherosclerosis is the most common cause of heart disease and stroke. Plaque thickness ≥4 mm in the ascending aorta or aortic arch is strongly correlated with cerebral embolic events and ischemic stroke. However, despite imaging workup, the cause of embolic stroke remains unidentified in many patients. Transesophageal echocardiography (TEE) is the preferred echocardiographic method for the evaluation of cardiac source of emboli. 2D TEE imaging evaluates aortic root and aortic arch in a single plane or two planes with biplane imaging. However, 2D TEE often fails to detect mobile or complex components in the ascending aorta and aortic arch plaques. The routine availability of 3D TEE in current ultrasound systems may significantly improve the assessment of aortic plaques as a potential embolic source. In this case series, we present four consecutive patients with stroke who underwent TEE by a single cardiologist for possible cardioembolic source. Some of these patients may have been labelled as “cryptogenic stroke” or “embolic stroke of undetermined source” (ESUS) due to the presence of insignificant or nonmobile ascending aortic or aortic arch plaques on 2D TEE imaging. In our four consecutive patients with ESUS who underwent TEE by a single operator, 3D TEE showed complex aortic arch plaques with ulceration with mobile components and established these plaques as the likely source of embolic stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Atherosclerotic Plaque and Stroke In Patients With Afmentioning

confidence: 99%

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Wen,

Naqvi

2024

Echocardiography

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“…Особое внимание следует уделить пожилым пациентам с сахарным диабетом и высокими значениями липопротеинов низкой плотности [35]. Сочетание АДА с фибрилляцией предсердий ассоциировано с повышенным риском повторного ИИ и неблагоприятного функционального исхода заболевания [36].…”

Section: результатыunclassified

Аortic arch atheroma as a source of arterio-arterial embolism and ischemic stroke

Ramazanov

Trofimova

Ковалева

et al. 2023

vmirvz

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Introduction. Currently, despite the introduction of modern diagnostic algorithms in 20-40 % of patients with ischemic stroke, it is not possible to establish its cause. Potential causes of acute cerebral ischemia in patients with cryptogenic ischemic stroke include paroxysmal atrial fibrillation, patent foramen ovale, atrial cardiomyopathy, carotid network, aortic arch atheroma, and cancer-associated thrombophilia.Target: to systematize data on methods for diagnosing and preventing aortic arch atheroma.Material and methods. The literature search was carried out in electronic search systems Scopus, eLibrary, PubMed using the key words: ischemic stroke, cryptogenic stroke, aortic arch atheroma, pathogenesis of ischemic stroke.Results. At present, despite such a detailed study of therapeutic strategies for the prevention of recurrent thrombotic events in patients with aortic arch atheroma, none of the drugs has proven its advantage. Although the NAVIGATE ESUS and RESPECT ESUS trials did not show the superiority of oral anticoagulants over antiplatelet agents in preventing recurrent ischemic strokes in patients with cryptogenic stroke, it was found that cryptogenic ischemic stroke is heterogeneous, which requires a differentiated approach to secondary prevention.Conclusion. Аortic atheroma can be the cause of embolic syndrome and cryptogenic stroke. The main methods for diagnosing aortic atheroma are transesophageal echocardiography and computed tomographic angiography. The therapeutic strategy for the treatment of aortic atheroma is lipid-lowering, antithrombotic therapy in combination with blockers of the renin-angiotensin-aldosterone system.

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“… 1 References 8 , 9 , 18 , 19 , 20 , 22 , 24 , 26 , 29 , 33 , 34 , 36 , 37 , 39 , 42 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 . …”

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Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

Sakai,

Cao,

Rubin

et al. 2023

JAHA

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Background Complex aortic plaque (CAP) is a potential embolic source in patients with cryptogenic stroke (CS). We review CAP imaging criteria for transesophageal echocardiogram (TEE), computed tomography angiography (CTA), and magnetic resonance imaging and calculate CAP prevalence in patients with acute CS. Methods and Results PubMed and EMBASE databases were searched up to December 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. Two independent reviewers extracted data on study design, imaging techniques, CAP criteria, and prevalence. The Cochrane Collaboration tool and Guideline for Reporting Reliability and Agreement Studies were used to assess risk of bias and reporting completeness, respectively. From 2293 studies, 45 were reviewed for CAP imaging biomarker criteria in patients with acute CS (N=37 TEE; N=9 CTA; N=6 magnetic resonance imaging). Most studies (74%) used ≥4 mm plaque thickness as the imaging criterion for CAP although ≥1 mm (N=1, CTA), ≥5 mm (N=5, TEE), and ≥6 mm (N=2, CTA) were also reported. Additional features included mobility, ulceration, thrombus, protrusions, and assessment of plaque composition. From 23 prospective studies, CAP was detected in 960 of 2778 patients with CS (0.32 [95% CI, 0.24–0.41], I 2 =94%). By modality, prevalence estimates were 0.29 (95% CI, 0.20–0.40; I 2 =95%) for TEE; 0.23 (95% CI, 0.15–0.34; I 2 =87%) for CTA and 0.22 (95% CI, 0.06–0.54; I 2 =92%) for magnetic resonance imaging. Conclusions TEE was commonly used to assess CAP in patients with CS. The most common CAP imaging biomarker was ≥4 mm plaque thickness. CAP was observed in one‐third of patients with acute CS. However, high study heterogeneity suggests a need for reproducible imaging methods.

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Coexisting of aortic arch atheroma and atrial fibrillation for short-term recurrence and poor functional outcome in acute stroke

Cited by 5 publications

References 36 publications

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Аortic arch atheroma as a source of arterio-arterial embolism and ischemic stroke

Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

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