J Korean Neurol Assoc.  2006 Apr;24(2):106-111.

Analysis of Ischemic Stroke Patterns Using the Diffusion-Weighted Imaging in Patients with Complicated Aortic Plaques

• Ha YS
• Han SW
• Cho KC
• Nama HS
• Kim JY
• Paik JS
• Park JH

Abstract

BACKGROUND: This study aimed at characterizing the lesion patterns in patients with acute ischemic stroke and complicated aortic plaques using the diffusion-weighted magnetic resonance imaging (DWI).
METHODS
We retrospectively reviewed 403 consecutive patients with acute ischemic stroke between January 2002 and December 2004, and enrolled patients who had received a trans-esophageal echocardiography (TEE). All the patients should have an acute cerebral infarction within 7 days of the onset of symptoms. We analyzed the ischemic lesion patterns on DWI in the patients who had aortic atheroma protruded into the lumen greater than 4 mm in the aortic arch or ascending aorta (complicated aortic plaques; CAP). Ischemic lesions were classified into subcortical, cortical and multiple infarctions. We investigated the accompanying risk factors for atherosclerosis and stenosis of the relevant major brain artery as well.
RESULTS
Of the 403 patients, TEE was performed in 210 (52%) and CAP was found in 25 (12%). Among 25 patients, subcortical infarction was observed in 15 (60%), followed by cortical infarction in 7 (28%), and multiple ischemic lesions in 3 (12%). CAP was frequently associated with hypertension and current smoking, and accompanied with stenosis of the relevant major brain artery as well (68%).
CONCLUSIONS
CAP may be a potential source of embolism. However, the high prevalence of the small subcortical lesion in this study questions the mechanisms of ischemic stroke in patients with aortic atheroma. CAP may be an uncomplicated marker of advanced systemic atherosclerosis including the cerebral arteries.

Keyword

Complicated aortic plaques; Ischemic stroke; Diffusion-weighted imaging

MeSH Terms

Aorta
Aorta, Thoracic
Arteries
Atherosclerosis
Brain
Cerebral Arteries
Cerebral Infarction
Constriction, Pathologic
Echocardiography
Embolism
Humans
Hypertension
Infarction
Magnetic Resonance Imaging
Plaque, Atherosclerotic
Prevalence
Retrospective Studies
Risk Factors
Smoke
Smoking
Stroke*
Smoke