Ulcerated plaques in the aortic arch contribute to symptomatic multiple brain infarction

Yoshimura, Sohei; Toyoda, Kazunori; Kuwashiro, Takahiro; Koga, Masatoshi; Otsubo, Ryoichi; Konaka, Kuni; Naganuma, Masaki; Matsuoka, Hideki; Minematsu, Kazuo

doi:10.1136/jnnp.2009.198606

Cited by 17 publications

(23 citation statements)

References 37 publications

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“…It is well known that AAA is associated with ischemic stroke [20,21]. However, AAA has received limited attention as an embolic source to the brain compared with atrial fibrillation and severe carotid stenosis [1].…”

Section: Discussionmentioning

confidence: 99%

Characterization of the Infarct Pattern Caused by Vulnerable Aortic Arch Atheroma: DWI and Multidetector Row CT Study

et al. 2012

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Background: Aortic arch atheroma (AAA) has been accepted as a possible embolic source in patients with ischemic stroke, especially cryptogenic stroke. However, despite its well-known role as a risk factor for stroke, research focused on the mechanism or characteristics of stroke caused by AAA is insufficient. In this study, we aimed to evaluate clinical and radiological characteristics including lesion pattern on DWI in acute stroke patients associated with vulnerable AAA detected by multidetector row computed tomography (MDCT). Methods: From September 2008 through May 2011, patients who presented with acute ischemic stroke and underwent MDCT were found in a prospective stroke registry. Patients without evident stroke etiology were included and classified by presence of vulnerable AAA. Vulnerable AAA was defined as (i) at least 6 mm thick adjacent to the aortic wall; (ii) ulcerated plaque, or (iii) soft plaque. Soft plaque was defined as the presence of clearly visualized area of hypoattenuation (<80 Hounsfield units) suggestive of thrombus. The patients without vulnerable AAA were classified as no/simple AAA group. The characteristics of diffusion-weighted MRI (DWI) lesions were analyzed in terms of the number and size of the lesions, and the involved vascular territories. Results: A total of 63 cryptogenic stroke patients were included in this study. Vulnerable AAA was observed in 15 (23.8%) patients. The patients with vulnerable AAA were older than those with no/simple AAA (p = 0.026). DWI analysis revealed that the vulnerable AAA group had a greater chance of having multiple and small lesions in multiple vascular territories that were mainly located in cortical and border-zone regions than the no/simple AAA group. Multiple logistic regression analysis showed that age (odds ratio 1.17; 95% confidence interval 1.02–1.34) and multiple small lesions in multiple vascular territories (odds ratio 33.18; 95% confidence interval 4.26–258.45) were independently associated with vulnerable AAA. Conclusion: Vulnerable AAA is independently associated with a DWI pattern characterized by multiple small scattered lesions in multiple vascular territories in conjunction with age. It may help determine stroke mechanism quickly and easily, and provide more information about the pathomechanism of vulnerable AAA-related stroke.

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Section: Discussionmentioning

confidence: 99%

Characterization of the Infarct Pattern Caused by Vulnerable Aortic Arch Atheroma: DWI and Multidetector Row CT Study

et al. 2012

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“…The thoracic aortic arch was observed in both transverse and sagittal views according to an established method as described in our previous study [3,7]. ACLs were defined by focal increases in IMT ≥4.0 mm or the presence of ulcerated or mobile plaques [3,9].…”

Section: Methodsmentioning

confidence: 99%

“…Aortic complicated lesions (ACLs), generally diagnosed on transesophageal echocardiography (TEE) are key findings for assessing aortic embolic sources among patients with embolic stroke [2,3,4,5,6]. Moreover, ACLs have been identified as an independent predictor for the recurrence [7] or poor prognosis [8] of ischemic stroke [4].…”

Section: Introductionmentioning

confidence: 99%

A Novel Evaluation for Predicting Aortic Complicated Lesions Using Calcification on Chest X-ray

Yamaguchi¹,

Yoshimura²,

Koga

et al. 2017

Cerebrovasc Dis

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Background: The aorta is a significant source of cerebral thromboembolisms. Aortic complicated lesions (ACLs) are key findings on transesophageal echocardiography (TEE) for assessing aortic sources of emboli to the brain. TEE is sometimes avoided due to its invasiveness. However, few reports have examined alternative methods for predicting ACLs. We investigated relationships between aortic arch calcification (AAC) on chest X-ray and ACLs. Methods: Participants comprised 300 patients with acute ischemic stroke or transient ischemic attack who underwent TEE for the evaluation of the aortic arch and heart. A postero-anterior plain chest X-ray in the recumbent position was evaluated on admission for each patient. AAC was evaluated using 4 grades (0-3) and “AAC thickness” defined as the distance from the inner margin of the most distant AAC to the outer margin of the aortic vessel wall. ACLs were defined by intima-media thickness (IMT) ≥4.0 mm or presence of ulcerated or mobile plaques. Carotid maximum IMT on ultrasonography was also evaluated. Comparison of the diagnostic ability to predict ACL was performed between AAC grades and AAC thickness or AAC thickness and carotid maximum IMT using the Delong method. Results: ACLs were identified in 71 patients (23.7%), including ACLs with ulcerated plaques in 24 (8.0%) and ACLs with mobile plaques in 9 (3.0%). Plaque thickness was greater in higher AAC grades or higher quartiles of AAC thickness (p for trend <0.001 each). The Cochran-Armitage test showed that both higher AAC grade and higher quartile of AAC thickness were significantly associated with the presence of ACLs, as well as the presence of ulcerated or mobile plaques (p for trend < 0.001 each). Receiver-operating characteristic (ROC) analysis showed optimal cut-off values for AAC thickness of 5.6 mm for ACLs and 6.0 mm for ulcerated or mobile plaques. Multivariate logistic regression revealed a higher grade of AAC (grades 2-3) and AAC thickness (≥6 mm) as significantly associated with ACLs and ulcerated or mobile plaques (p < 0.001 each). ROC curve comparisons showed that AAC thickness offered a better marker of ACLs than AAC grade (p = 0.019), although no significant difference was evident between AAC thickness and carotid maximum IMT (p = 0.567). Conclusions: AAC on chest X-ray, evaluated by both AAC grade and AAC thickness to the outer aortic vessel wall, was significantly associated with ACLs on TEE. AAC thickness was suggested as more useful than AAC grade and equivalent to carotid IMT in predicting ACLs.

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“…The thoracic aortic arch was observed mainly in sagittal and sometimes transverse views, according to the method established in our previous study [6,10]. The transition zone between the descending aorta and aortic arch was defined as the area in which the oval shape of the lumen of the descending aorta in the transverse (0°) view became straight.…”

Section: Tee Studymentioning

confidence: 99%

“…Transesophageal echocardiography (TEE) can provide concrete information about the aortic arch. Aortic complicated lesions (ACLs), usually diagnosed on TEE, are key parameters for evaluating aortic embolic sources in cases of embolic stroke [2,[6][7][8][9]. In addition, ACLs have been suggested as independent predictors of recurrence [10] and poor prognosis [11] among ischemic stroke patients.…”

Section: Introductionmentioning

confidence: 99%

Associations of High Intensities on Magnetization-Prepared Rapid Acquisition with Gradient Echo with Aortic Complicated Lesions in Ischemic Stroke Patients

et al. 2019

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Background: Aortic complicated lesions (ACLs) are key parameters for evaluating aortic embolic sources in embolic stroke, and are usually diagnosed using transesophageal echocardiography (TEE). However, alternative methods for diagnosing ACLs have not been well established. We investigated associations between high-intensity areas on T1-weighted imaging (T1WI) with magnetization-prepared rapid acquisition with gradient echo (MPRAGE) and ACLs on TEE among ischemic stroke patients. Methods: Participants comprised 135 patients (mean age, 71 years; 35 women) with ischemic stroke or transient ischemic attack who underwent TEE for evaluation of embolic sources and plaque imaging using MPRAGE for evaluation of aortic or carotid plaques. Aortic plaque with signal intensity ≥200% of sternocleidomastoid intensity on MPRAGE was categorized as “high intensity”. ACLs on TEE were defined by focal increases in intima-media thickness (IMT) ≥4.0 mm or the presence of ulcerated or mobile plaques. Results: Fifty-six patients (42%) showed high-intensity areas on MPRAGE at the aortic arch. Aortic maximum IMT was significantly higher in patients with high intensities than in those without (p < 0.001). Incidences of ACLs (66 vs. 20%, p < 0.001) or ulcerated or mobile plaques (30 vs. 6%, p < 0.001) were significantly higher in patients with high intensities than in patients without. Multivariable logistic regression analysis showed that high intensities on MPRAGE were independently associated with the presence of ACLs (OR 5.72; 95% CI 2.38–13.70) and ulcerated or mobile plaques (OR 4.18; 95% CI 1.29–13.50). Conclusions: High intensities on T1WI with MPRAGE in the aortic arch were significantly associated with the presence of ACLs. An evaluation of the aortic arch using MPRAGE may be useful for predicting ACLs.

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Ulcerated plaques in the aortic arch contribute to symptomatic multiple brain infarction

Abstract: Ulcerated plaque in the aortic arch was associated with the development of ischaemic stroke, especially multiple brain infarcts, probably involving, at least in part, an embolic mechanism.

Cited by 17 publications

References 37 publications

Characterization of the Infarct Pattern Caused by Vulnerable Aortic Arch Atheroma: DWI and Multidetector Row CT Study

Characterization of the Infarct Pattern Caused by Vulnerable Aortic Arch Atheroma: DWI and Multidetector Row CT Study

A Novel Evaluation for Predicting Aortic Complicated Lesions Using Calcification on Chest X-ray

Associations of High Intensities on Magnetization-Prepared Rapid Acquisition with Gradient Echo with Aortic Complicated Lesions in Ischemic Stroke Patients

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