J. Weinberger et al., Plaque morphology correlates with cerebrovascular symptoms in patients with complex aortic arch plaque, ARCH NEUROL, 57(1), 2000, pp. 81-84
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.