Aortic plaque as a potential cause for cerebral ischemia

Abstract

The purpose of this study was to determine the prevalence, clinical significance, and embolic potential of thoracic aortic plaque in patients with cerebral ischemia and to further study the correlation of aortic plaque with carotid or heart disease. We used transesophageal echography (TEE) to evaluate potential source of emboli in aortic arch and heart, and duplex in carotid artery. A atherosclerotic lesion of aortic arch was defined as normal (0), mild plaque (1), moderate plaque (2) and protruding plaque or mobile plaque (3). 75 of 100 patients were found to have atherosclerotic lesion in aortic arch. 16 of 75 patients over degree 2 exhibited no pathologic finding of heart or carotid and 4 of 16 patients were classified as degree 3. The pathologic findings of heart and carotid were significantly correlated with aortic plaque. Age, diabetes, CAD were also significantly correlated with aortic plaque. Aortic atherosclerosis was common in cerebral ischemia. Aortic plaque might be responsible for not only some unexplained embolic events, but also for some of the embolie stroke in patient who have carotid artery or heart disease. Age, diabetes, CAD might be important risk factors in the development of atherosclerotic lesion in the aortic arch.

Keywords

embolism / cerebral ischemia / echocardiography

References

[1] SewardJ B, KhandheriaB K, OhJ K, et al. . Transesophageal echocardiography: technique, anatomic correlation, implementation, and clinical applications. Mayo Clin Proc, 1988, 63: 649-649

[2] BealM F, WilliamsR S, RichardsonE P, et al. . Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction. Neurology, 1981, 31: 860-860

[3] ToyodaK, YasakaM, NagataS, et al. . Aortogenic embolic stroke: A transesophageal echocardiographic approach. Stroke, 1992, 23: 1056-1056

[4] TunickP A, PerezJ L, KronzonL. Protruding atheromas in the thoracic aorta and systemic embolization. Ann Int Med, 1991, 115: 423-423

[5] PaulA, TunickP A, KrozonI. Protruding atherosclerotic plaque in the aortic arch of patients with systemic embolization: A new finding seen by transesophageal echocardiography. Am Heart J, 1990, 120: 658-658

[6] FisherC M, GoreI, OkabeN, et al. . Atherosclerosis of the carotid and vertebral arteries-Extracranial and intracranial. J Neuropathol Exp Neurol, 1965, 24: 455-455

[7] KaralisD G, ChandrasekarenK, VictorM F, et al. . Recognition and embolie potential of intraaortic atherosclerotic debris. J Am Coll Cardio, 1991, 17: 73-73

[8] MasunoriM, OnoS, TomochikaY, et al. . Advance in transesophageal echocardiography for the evaluation of atherosclerotic lesion in the thoracic aorta—The effects of hypertension, hypercholesterolemia, and aging on atherosclerotic lesion. Jpn Circ J, 1992, 56: 592-592

[9] VihertA M. Atherosclerosis of the aorta in five towns. Bull WHO, 1976, 53: 501-501

[10] OnoS, MatsuzakiM, MichishigeH, et al. . Estimation of atherosclerotic lesions in the thoracic aorta by transesophageal echocardiography. J Cardiol (Suppl), 1991, 26: 57-57

[11] FazioG P, RedbergR F, WinslowF T, et al. . Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary disease. J Am Coll Cardio, 1993, 21: 144-144

[12] ToblerH G, EdwardsJ E. Frequency and location of atherosclerotic plaques in the ascending aorta. J Thorac Cardiovasc Surg, 1988, 96: 304-304

[13] SimonsA J, CarlsonR, HareCL, et al. . The use of transesophageal echocardiography in detecting aorta atherosclerosis in patients with embolie disease. Am Heart J, 1992, 123: 224-224

[14] ThieleB L, YoungJ V, ChikosP M, et al. . Correlation of arteriographie findings and symptoms irl cerebraovascular disease. Neurology, 1980, 30: 1041-1041

[15] ComeP C, RileyM F, BivasN K. Roles of echocardiography and arrhythmia monitoring in the evaluation of patients with suspected systemic embolism. Ann Neurol, 1983, 13: 527-527