ULCERATED ATHEROSCLEROTIC PLAQUES IN THE THORACIC AORTA ARE ASSOCIATED WITH CRYPTOGENIC STROKE - A MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

Atherosclerotic plaque ulcers greater than or equal to 2 mm in depth a nd width in the thoracic aorta have been implicated by autopsy study a s a cause of unexplained or cryptogenic ischemic strokes. Transesophag eal echocardiography (TEE) allows visualization of complex atheroscler otic lesions of the thoracic aorta. We compared the prevalence of thor acic aorta ulcerated plaques (ulcers greater than or equal to 2 mm in both depth and width) in three age-matched groups undergoing multiplan e TEE: group 1, 23 patients with cryptogenic ischemic stroke; group 2, 26 patients with known-cause strokes; and group 3, 57 control patient s without strokes. TEEs were interpreted in a blinded fashion. Ulcerat ed plaques were found in 9 (39%) group 1 patients but in only 2 (8%) g roup 2 patients and in only 4 (7%) group 3 patients (p < 0.001). There was,an association between advancing age and the presence of ulcerate d plaques (p < 0.02). We conclude that ulcerated atherosclerotic plaqu es in the thoracic aorta are associated with cryptogenic ischemic stro ke and should be considered a potential source of cerebral emboli.