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Previous Volume 331:1474-1479 December 1, 1994 Number 22 Next

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ABSTRACT

Background Atherosclerotic disease of the aortic arch has been suspected to be a potential source of cerebral emboli. We conducted a study to quantify the risk of ischemic stroke associated with atherosclerotic disease of the aortic arch.

Methods Using transesophageal echocardiography, we performed a prospective case-control study of the frequency and thickness of atherosclerotic plaques in the ascending aorta and proximal arch in 250 consecutive patients admitted to the hospital with ischemic stroke and 250 consecutive controls, all over the age of 60 years.

Results Atherosclerotic plaques 4 mm in thickness were found in 14.4 percent of the patients but in only 2 percent of the controls. After adjustment for atherosclerotic risk factors, the odds ratio for ischemic stroke among patients with such plaques was 9.1 (95 percent confidence interval, 3.3 to 25.2; P<0.001). Among the 78 patients who had brain infarcts with no obvious cause, 28.2 percent had plaques 4 mm in thickness, as compared with 8.1 percent of the 172 patients who had infarcts whose possible or likely causes were known (odds ratio, 4.7; 95 percent confidence interval, 2.2 to 10.1; P<0.001). Plaques of 4 mm in the aortic arch were not associated with the presence of atrial fibrillation or stenosis of the extracranial internal carotid artery. In contrast, plaques that were 1 to 3.9 mm thick were frequently associated with carotid stenosis of 70 percent.

Conclusions These results indicate a strong, independent association between atherosclerotic disease of the aortic arch and the risk of ischemic stroke. The association was particularly strong with thick plaques. Atherosclerotic disease of the aortic arch should be regarded as a risk factor for ischemic stroke and as a possible source of cerebral emboli.

Source Information

From the Services de Neurologie (P.A., P.-J.T., M.-G.B.) and Cardiologie (A.C., C.C.), Hopital Saint-Antoine, Universite Pierre et Marie Curie, Paris; INSERM, Unite 360, Recherches Epidemiologiques en Neurologie et Psychopathologie, Villejuif, France (C.T.); and the Cliniques Neurologique (M.H., G.B.) and Cardiologique (B.B.), Centre Hospitalier Universitaire de Grenoble, Grenoble, France.

Address reprint requests to Dr. Amarenco at the Service de Neurologie, Hopital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75571 Paris CEDEX 12, France.

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Atherosclerotic Disease of the Aortic Arch and the Risk of Ischemic Stroke
Koren M. J., Bryant B., Hilton T. C., Joffe I. I., Jacobs L. E., Lampert C., Kotler M. N., Amarenco P., Cohen A., Hommel M., Bousser M.-G., Kistler J. P.
Extract | Full Text  
N Engl J Med 1995; 332:1237-1238, May 4, 1995. Correspondence

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