Complex atheromatous plaques in the descending aorta and the risk of stroke: a systematic review and meta-analysis

Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic ce...

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Veröffentlicht in:	Stroke (1970) Jg. 45; H. 6; S. 1764
Hauptverfasser:	Katsanos, Aristeidis H, Giannopoulos, Sotirios, Kosmidou, Maria, Voumvourakis, Konstantinos, Parissis, John T, Kyritsis, Athanassios P, Tsivgoulis, Georgios
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.06.2014
Schlagworte:	Aged Aged, 80 and over Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - metabolism Aorta, Thoracic - physiopathology Cerebral Infarction - diagnostic imaging Cerebral Infarction - etiology Cerebral Infarction - metabolism Cerebral Infarction - physiopathology Echocardiography, Transesophageal Female Humans Intracranial Embolism - diagnostic imaging Intracranial Embolism - etiology Intracranial Embolism - metabolism Intracranial Embolism - physiopathology Male Middle Aged Plaque, Atherosclerotic - complications Plaque, Atherosclerotic - diagnostic imaging Plaque, Atherosclerotic - metabolism Plaque, Atherosclerotic - physiopathology aorta, thoracic atherosclerosis brain ischemia stroke
ISSN:	1524-4628, 1524-4628
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Zusammenfassung:	Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 ObjectType-Undefined-4
ISSN:	1524-4628 1524-4628
DOI:	10.1161/STROKEAHA.114.005190