Plaque morphology correlates with cerebrovascular symptoms in patients with complex aortic arch plaque

Background: Studies of aortic arch plaques with transesophageal echocardiog raphy have demonstrated that complex aortic arch plaques (CAPs) greater tha n or equal to 4 mm in thickness are associated with ischemic stroke. Recent studies have demonstrated that the morphological features of plaques may a id in the identification of aortic plaques that are more likely to be assoc iated with embolic stroke. Objective: To identify aortic plaques that are more likely to be associated with embolic stroke by means of their morphological features. Methods: Transcutaneous B-mode ultrasonography was used to image aortic arc h plaques in 500 consecutive patients. The criteria used to identify the mo rphological features of carotid artery plaques that are more likely to be a ssociated with ischemic stroke (heterogeneous rather than homogeneous) were applied to aortic arch plaques. Statistical comparisons were made using th e Fisher exact test. Results: Ischemic symptoms (eg, stroke, transient ischemic attack, and amau rosis fugax) were present in 38% of 104 patients with CAP and in 34% of 391 patients without CAP. Nineteen (51%) of 37 patients with heterogeneous CAP were symptomatic. Twenty-one (31%) of 67 patients with homogeneous CAP wer e symptomatic (P = .04). Conclusion: Transcutaneous B-mode ultrasonography of the: aortic arch can h elp to identify heterogeneous plaques that are more likely to be associated with ischemic stroke using morphological criteria derived from studies of carotid artery plaque.