American Heart Journal

1995

DOI: 10.1016/0002-8703(95)90243-0

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Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: A multiplane transesophageal echocardiographic study

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Marian P. LaMonte

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et al.

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Treatments For Stroke Patients With Other Specific Condition1

Discussion1

Tee Assessment Of Aa Atheroma1

Rundek Et Al Arch Atheromas and High-intensity Transient Sig1

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Cited by 105 publications

(67 citation statements)

References 15 publications

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“…The risk of atheroembolism from aortic plaque during cardiac or aortic surgery has been well recognized for many decades, and various surgical strategies or alternatives to surgery have been developed for mitigating this risk. 578,579 In an early autopsy series, Amarenco et al 573 determined that among 500 consecutive patients with cerebrovascular and other neurological diseases, ulcerated plaques in the aortic arch were more common in those with versus without evidence of cerebrovascular disease (26% versus 5%; P<0.001). After controlling for age and heart weight, the adjusted OR was 4.0 (P<0.001).…”

Section: Treatments For Stroke Patients With Other Specific Conditionmentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

et al. 2014

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

“…The risk of atheroembolism from aortic plaque during cardiac or aortic surgery has been well recognized for many decades, and various surgical strategies or alternatives to surgery have been developed for mitigating this risk. 578,579 In an early autopsy series, Amarenco et al 573 determined that among 500 consecutive patients with cerebrovascular and other neurological diseases, ulcerated plaques in the aortic arch were more common in those with versus without evidence of cerebrovascular disease (26% versus 5%; P<0.001). After controlling for age and heart weight, the adjusted OR was 4.0 (P<0.001).…”

Section: Treatments For Stroke Patients With Other Specific Conditionmentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

et al. 2014

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

“…These complex lesions were strongly associated with stroke in both men and women in the present study as well as in previous studies. 14,15 As we have recently reported for the same population, 11 large complex plaques appear as a possible culprit for stroke, whereas equally large but noncomplex lesions are associated with only a modest increase in stroke risk. This combined information seems to suggest that although complex morphological features of the plaque may be directly involved in the stroke mechanism, plaque thickness in itself may primarily be a marker of increased risk, the underlying reasons for which may somewhat differ between men and women.…”

Section: Discussionmentioning

confidence: 73%

Gender Differences in the Risk of Ischemic Stroke Associated With Aortic Atheromas

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et al. 2000

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Background and Purpose-Atherosclerotic plaque of the proximal portion of the aorta is associated with an increased risk of ischemic stroke in the elderly. Different cutoffs of plaque thickness have been used in the literature for risk stratification and have been applied to both men and women. However, the assumption that the relationship between plaque thickness and stroke risk is the same in the 2 genders has not been proven. The aim of this study was to evaluate whether the prevalence of different degrees of aortic plaque thickness differed in men and women with ischemic stroke. Methods-We performed transesophageal echocardiography in 152 patients aged Ͼ59 years with acute ischemic stroke (76 men and 76 women) and in 152 control subjects of similar age (70 men and 82 women). Odds ratios (ORs) for ischemic stroke with 95% CIs for different plaque thickness definitions were calculated for the overall group and separately for men and women by logistic regression analysis after adjusting for age, arterial hypertension, and hypercholesterolemia. Results-Aortic plaques Ն4 mm were significantly more frequent in men than in women (31.5% versus 20.3%, respectively; Pϭ0.025) and were associated with ischemic stroke in both men (adjusted OR 6.0, CI 2.1 to 16.8) and women (adjusted OR 3.2, CI 1.2 to 8.8). However, plaques 3 to 3.9 mm in thickness had a significant association with stroke in women (adjusted OR 4.8, CI 1.7 to 15.0) but not in men (adjusted OR 0.8, CI 0.2 to 3.0). Plaques Ͻ3 mm were not associated with a significantly increased stroke risk for either sex. Conclusions-Smaller aortic plaques are significantly associated with ischemic stroke in women but not in men. If the increased prevalence of smaller plaques in women is confirmed to be associated with increased risk for embolic stroke, different cutoff points may have to be adopted in men and women for risk stratification and for decisions regarding medical intervention.

“…17 Ulcerated plaques were defined as having 1 or more craters Ն2 mm in depth and width. 18 Complex mobile plaques were defined as those that protruded, were Ն4 mm in maximum thickness, and were associated with mobile lesions that were suggestive of "debris" or a free-floating thrombus. 19 …”

Section: Tee Assessment Of Aa Atheromamentioning

confidence: 99%

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

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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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