P. Amarenco et al., ATHEROSCLEROTIC DISEASE OF THE AORTIC-ARCH AS A RISK FACTOR FOR RECURRENT ISCHEMIC STROKE, The New England journal of medicine, 334(19), 1996, pp. 1216-1221
Background. Atherosclerotic disease of the aortic arch is found in 60
percent of patients 60 years of age or older who have had brain infarc
tion. The aim of this study was to determine whether atherosclerotic p
laques in the aortic arch are a risk factor for recurrent brain infarc
tion and for vascular events in general (i.e., brain infarction, myoca
rdial infarction, peripheral embolism, and death from vascular causes)
. Methods. For a period of two to four years, we followed a cohort of
331 patients 60 years of age or older who were consecutively admitted
to the hospital with brain infarction (a total of 788 person-years of
follow-up). All patients underwent transesophageal echocardiography to
determine whether atherosclerotic plaques were present in the aortic
arch proximal to the ostium of the left subclavian artery. The patient
s were divided into three groups according to the thickness of the wal
l of the aortic arch (<1 mm, 1 to 3.9 mm, and greater than or equal to
4 mm). Results. The incidence of recurrent brain infarction was 11.9
per 100 person-years in patients with an aortic-wall thickness of grea
ter than or equal to 4 mm, as compared with 3.5 per 100 person-years i
n patients with a wall thickness of 1 to 3.9 mm and 2.8 per 100 person
-years in patients with a wall thickness of <1 mm (P<0.001). The overa
ll incidence of vascular events was 26.0, 9.1, and 5.9 per 100 person-
years of follow-up in the respective groups (P<0.001). After adjustmen
t for the presence of carotid stenosis, atrial fibrillation, periphera
l arterial disease, and other risk factors, aortic plaques greater tha
n or equal to 4 mm thick (including the thickness of the aortic wall)
were found to be independent predictors of recurrent brain infarction
(relative risk, 3.8; 95 percent confidence interval, 1.8 to 7.8; P=0.0
012) and of all vascular events (relative risk, 3.5; 95 percent confid
ence interval, 2.1 to 5.9; P<0.001). Conclusions. Atherosclerotic plaq
ues greater than or equal to 4 mm thick in the aortic arch are signifi
cant predictors of recurrent brain infarction and other vascular event
s. (C) 1996, Massachusetts Medical Society.