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Different infarction patterns in patients with aortic atheroma compared to those with cardioembolism or large artery atherosclerosis

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Abstract

Aortic atheroma is a known cause of ischemic stroke. However, it is unclear whether ischemic stroke is caused by emboli from aortic atheroma or by accompanying atherosclerosis. In this study, we evaluated lesion patterns of patients with complex aortic plaque (CAP) to assume the underlying pathophysiology. Acute ischemic stroke patients who underwent transesophageal echocardiography were included. CAP was defined as a plaque in the proximal aorta ≥ 4 mm thick or with a mobile component. The diffusion-weighted imaging lesion patterns of patients with CAP were compared to those with large arterial atherosclerosis (LAA) or cardioembolism (CE). A total of 64 CAP patients, 127 LAA patients, and 80 CE patients were included. Small cortical pattern was more common in the CAP group (45.3%) than in the LAA (7.9%, p < 0.001) or the CE group (23.8%, p = 0.018). A large cortical pattern was more common in the CE group than in the CAP group (p < 0.001), whereas subcortical only pattern tended to be more common in the CAP group than in the CE group (p = 0.057). In multinominal analysis, the CAP group was more likely to have a small cortical lesion than the LAA group [odds ratio (OR) 14.63; 95% confidence interval (CI) 4.67–45.85] or the CE (OR 3.69, 95% CI 1.19–11.39) group. In conclusion, patients with CAP frequently had small cortical lesions or subcortical single lesion. These findings imply that ischemic stroke in aortic atheroma patients is associated with either small emboli or small artery disease.

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References

  1. Meissner I, Khandheria BK, Sheps SG, Schwartz GL, Wiebers DO, Whisnant JP, Covalt JL, Petterson TM, Christianson TJ, Agmon Y (2004) Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol 44:1018–1024

    Article  PubMed  Google Scholar 

  2. Zavala JA, Amarrenco P, Davis SM, Jones EF, Young D, Macleod MR, Horky LL, Donnan GA (2006) Aortic arch atheroma. Int J Stroke 1:74–80

    Article  PubMed  Google Scholar 

  3. Kang DW, Chalela JA, Ezzeddine MA, Warach S (2003) Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes. Arch Neurol 60:1730–1734

    Article  PubMed  Google Scholar 

  4. Wessels T, Wessels C, Ellsiepen A, Reuter I, Trittmacher S, Stolz E, Jauss M (2006) Contribution of diffusion-weighted imaging in determination of stroke etiology. AJNR Am J Neuroradiol 27(1):35–39

    CAS  PubMed  Google Scholar 

  5. Roh JK, Kang DW, Lee SH, Yoon BW, Chang KH (2000) Significance of acute multiple brain infarction on diffusion-weighted imaging. Stroke 31:688–694

    Article  CAS  PubMed  Google Scholar 

  6. Kim SJ, Ryoo S, Hwang J, Noh HJ, Park JH, Choe YH, Bang OY (2012) Characterization of the infarct pattern caused by vulnerable aortic arch atheroma: DWI and multidetector row CT study. Cerebrovasc Dis 33:549–557

    Article  PubMed  Google Scholar 

  7. Ueno Y, Kimura K, Iguchi Y, Shibazaki K, Inoue T, Hattori N, Urabe T (2007) Mobile aortic plaques are a cause of multiple brain infarcts seen on diffusion-weighted imaging. Stroke J Cerebr Circ 38:2470–2476

    Article  Google Scholar 

  8. Ha YS, Han SW, Cho KC, Nam HS, Kim JY, Paik JS, Park JH (2006) Analysis of ischemic stroke patterns using the diffusion-weighted imaging in patients with complicated aortic plaques. J Korean Neurol Assoc 24(2):106–111

    Google Scholar 

  9. Lee BI, Nam HS, Heo JH, Kim DI (2001) Yonsei Stroke Registry. Analysis of 1000 patients with acute cerebral infarctions. Cerebrovasc Dis 12:145–151

    Article  CAS  PubMed  Google Scholar 

  10. Nam HS, Kim HC, Kim YD, Lee HS, Kim J, Lee DH, Heo JH (2012) Long-term mortality in patients with stroke of undetermined etiology. Stroke 43:2948–2956

    Article  PubMed  Google Scholar 

  11. Nam HS, Han SW, Lee JY, Ahn SH, Ha JW, Rim SJ, Lee BI, Heo JH (2006) Association of aortic plaque with intracranial atherosclerosis in patients with stroke. Neurology 67:1184–1188

    Article  CAS  PubMed  Google Scholar 

  12. Cho HJ, Choi HY, Kim YD, Nam HS, Han SW, Ha JW, Chung NS, Heo JH (2010) Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history. J Neurol Neurosurg Psychiatry 81:412–415

    Article  PubMed  Google Scholar 

  13. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41

    Article  PubMed  Google Scholar 

  14. van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP (1998) Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 29:1783–1790

    Article  PubMed  Google Scholar 

  15. Roberts TP, Rowley HA (2003) Diffusion weighted magnetic resonance imaging in stroke. Eur J Radiol 45:185–194

    Article  PubMed  Google Scholar 

  16. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1996) Arterial territories of human brain: brainstem and cerebellum. Neurology 47:1125–1135

    Article  CAS  PubMed  Google Scholar 

  17. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708

    Article  CAS  PubMed  Google Scholar 

  18. Mangla R, Kolar B, Almast J, Ekholm SE (2011) Border zone infarcts: pathophysiologic and imaging characteristics. Radiographics 31:1201–1214

    Article  PubMed  Google Scholar 

  19. Yong SW, Bang OY, Lee PH, Li WY (2006) Internal and cortical border-zone infarction: clinical and diffusion-weighted imaging features. Stroke 37:841–846

    Article  PubMed  Google Scholar 

  20. Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, Price TR, Hier DB (1993) Brain infarction severity differs according to cardiac or arterial embolic source. Neurology 43:728–733

    Article  CAS  PubMed  Google Scholar 

  21. Friedman M, Van den Bovenkamp GJ (1966) The pathogenesis of a coronary thrombus. Am J Pathol 48:19–44

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Minnerup J, Kleinschnitz C (2011) Visualization of clot composition in ischemic stroke: do we get what we see? Stroke 42:1193–1194

    Article  PubMed  Google Scholar 

  23. Ogata J, Yutani C, Otsubo R, Yamanishi H, Naritomi H, Yamaguchi T, Minematsu K (2008) Heart and vessel pathology underlying brain infarction in 142 stroke patients. Ann Neurol 63:770–781

    Article  PubMed  Google Scholar 

  24. Ezzeddine MA, Primavera JM, Rosand J, Hedley-Whyte ET, Rordorf G (2000) Clinical characteristics of pathologically proved cholesterol emboli to the brain. Neurology 54:1681–1683

    Article  CAS  PubMed  Google Scholar 

  25. Lee DK, Kim JS, Kwon SU, Yoo SH, Kang DW (2005) Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion-weighted imaging study. Stroke 36:2583–2588

    Article  PubMed  Google Scholar 

  26. Min WK, Park KK, Kim YS, Park HC, Kim JY, Park SP, Suh CK (2000) Atherothrombotic middle cerebral artery territory infarction: topographic diversity with common occurrence of concomitant small cortical and subcortical infarcts. Stroke 31:2055–2061

    Article  CAS  PubMed  Google Scholar 

  27. Masuda J, Yutani C, Ogata J, Kuriyama Y, Yamaguchi T (1994) Atheromatous embolism in the brain: a clinicopathologic analysis of 15 autopsy cases. Neurology 44:1231–1237

    Article  CAS  PubMed  Google Scholar 

  28. Song TJ, Kim YD, Yoo J, Kim J, Chang HJ, Hong GR, Shim CY, Song D, Heo JH, Nam HS (2016) Association between aortic atheroma and cerebral small vessel disease in patients with ischemic Stroke. J Stroke 18:312–320

    Article  PubMed  PubMed Central  Google Scholar 

  29. Chuang ML, Gona P, Oyama-Manabe N, Manders ES, Salton CJ, Hoffmann U, Manning WJ, O’Donnell CJ (2014) Risk factor differences in calcified and noncalcified aortic plaque: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 34:1580–1586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Khan U, Porteous L, Hassan A, Markus HS (2007) Risk factor profile of cerebral small vessel disease and its subtypes. J Neurol Neurosurg Psychiatry 78:702–706

    Article  PubMed  PubMed Central  Google Scholar 

  31. O’Rourke MF, Safar ME (2005) Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 46:200–204

    Article  PubMed  Google Scholar 

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Correspondence to Hyo Suk Nam.

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This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C1056).

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Kim, S.W., Kim, Y.D., Chang, HJ. et al. Different infarction patterns in patients with aortic atheroma compared to those with cardioembolism or large artery atherosclerosis. J Neurol 265, 151–158 (2018). https://doi.org/10.1007/s00415-017-8685-7

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  • DOI: https://doi.org/10.1007/s00415-017-8685-7

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