Department of Cardiology, Dr.Shariati Hospital, Tehran, Iran
Background- Nowadays, the pathogenic role of atherosclerosis of the aorta in embolic stroke is well understood. TEE continues to play a prominent role in the evaluation of patients with stroke and finding the source of emboli. TEE shows that the incidence of strokes presumed to have a cardioembolic origin varies from 13-40% and that atherosclerotic disease of the aortic arch has been found in 40-60% of cerebral emboli. We investigated the prevalence and severity of atherosclerotic aortic plaques in patients with embolic stroke to ascertain their role as a risk factor for ischemic cerebral events.
Methods- Using TEE, we performed a cross-sectional study of the frequency and severity of aortic plaques in 60 patients admitted with ischemic stroke. Major atherosclerotic risk factors and the presence of coronary artery disease and carotid plaques were also surveyed.
Results- TEE detected at least one potential source of embolism in 48 patients, aortic plaques in 29, carotid plaques in 11 and cardiac pathologies in 19. Atrial fibrillation and valvular heart diseases (mostly mitral stenosis) were the most prevalent cardiac anomalies. The remaining 12 patients were regarded as cryptogenic cases. Fifty patients had at least one major risk factor of CAD. The majority of the plaques was detected in the arch and ascending aorta; of these 13.7% were complicated (grade III). There was a significant relation between aortic plaques and hypertension, male sex and CAD. Aortic calcification in CXR was strongly predictive of aortic plaques but not a sensitive criterion.
Conclusion- Abnormalities are commonly found by TEE in patients with stroke. The results indicate a strong, independent association between atherosclerosis of the aorta and risk of stroke. TEE should be considered in patients after stroke as a routine test and ultimately for prophylaxis and treatment of stroke.