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Association of aortic plaque with intracranial atherosclerosis in patients with stroke

From the Department of Neurology and National Core Research Center for Nanomedical Technology (J.Y.L., S.H.A., B.I.L., J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (H.S.N.), Ajou University College of Medicine (new affiliation after work done at the Yonsei University); Department of Neurology (S.W.H.), Sanggye Paik Hospital, Inje University College of Medicine; Department of Cardiology (J.-W.H., S.-J.R.), Yonsei University College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Dr. Ji Hoe Heo, Department of Neurology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-ku, 120-752, Seoul, Korea; e-mail: jhheo{at}yumc.yonsei.ac.kr

Objective: To determine whether there is a relationship between aortic plaques and intracranial (IC) atherosclerosis.

Methods: We reviewed 922 patients with stroke who had both transesophageal echocardiography and cerebral angiography. The plaques of these patients were classified as either complex aortic plaques (CAP), which protruded 4 mm or were present as mobile lesions in the proximal aorta, or simple aortic plaques (SAP), which were <4 mm or present in the descending aorta. Cerebral artery atherosclerosis was classified as either an IC or extracranial (EC) atherosclerosis.

Results: Among the 922 patients, we found aortic plaques in 237 patients (26%). There were 111 (47%) patients of SAP, 74 (31%) patients with CAP, and 52 (22%) patients that had both SAP and CAP. Angiography showed IC or EC atherosclerosis in 511 patients (55%). The presence of aortic plaques was significantly associated with IC or EC atherosclerosis. The significance appeared to be due to the strong association between the presence of SAP and IC atherosclerosis (51% SAP vs 35% no plaques; odds ratio = 1.94, 95% CI: 1.17 to 3.21). In the multiple logistic regression analysis, SAP were independent predictors of IC atherosclerosis

Conclusions: The presence of simple aortic plaques may be a marker of advanced vascular disease. Detection of simple aortic plaques during transesophageal echocardiography may have clinical implications because patients with these plaques frequently had concomitant intracranial atherosclerosis, a risk factor for stroke.

Supported by KOSEF through the National Core Research Center for Nanomedical Technology (R15-2004-024-00000-0).

Disclosure: The authors report no conflicts of interest.

Received January 3, 2006. Accepted in final form June 12, 2006.

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