Current Atherosclerosis Reports

, Volume 8, Issue 4, pp 343–346 | Cite as

Aortic arch atheroma and the risk of stroke

  • Pierre Amarenco
  • Joachim Röther
  • Patrik Michel
  • Steven M. Davis
  • Geoffrey A. Donnan
Article

Abstract

Brain infarction of unknown cause, known as cryptogenic stroke, represents 30% to 40% of all ischemic strokes, or approximately 400,000 cases each year in western Europe. In this category of patients new potential causes, such as aortic arch atheroma in the elderly, have been investigated in the past two decades.

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References and Recommended Reading

  1. 1.
    Amarenco P, Duyckaerts C, Tzourio C, et al.: The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med 1992, 326:221–225PubMedCrossRefGoogle Scholar
  2. 2.
    Khathibzadeh M, Mitusch R, Stierle U, et al.: Aortic atherosclerotic plaques as a source of systemic embolism. J Am Coll Cardiol 1996, 27:664–669CrossRefGoogle Scholar
  3. 3.
    Amarenco P, Cohen A, Tzourio C, et al.: Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 1994, 331:1474–1479.PubMedCrossRefGoogle Scholar
  4. 4.
    Jones EF, Kalman JM, Calafiore P, et al.: Proximal aortic atheroma. An independent risk factor for cerebral ischemia. Stroke 1995, 26:218–224.PubMedGoogle Scholar
  5. 5.
    Tunick PA, Perez JL, Kronzon I: Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med 1991, 115:423–427.PubMedGoogle Scholar
  6. 6.
    Nihoyannopoulos P, Joshi J, Athanasopoulos G, Oakley CM: Detection of atherosclerotic lesions in the aorta by transesophageal echography. Am J Cardiol 1993, 71:1208–1212.PubMedCrossRefGoogle Scholar
  7. 7.
    Stone DA, Hawke MW, LaMonte M, et al.: Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: a multiplane trasesophageal echocardiographic study. Am Heart J 1995, 130:105–108.PubMedCrossRefGoogle Scholar
  8. 8.
    Di Tullio MR, Sacco RL, Gersony D, et al.: Aortic atheromas and acute ischemic stroke: a transesophageal echocardiographic study in an ethnically mixed population. Neurology 1996, 46:1560–1566.PubMedGoogle Scholar
  9. 9.
    Dávila-Román VG, Barzilai B, Wareing TH, et al.: Atherosclerosis of the ascending aorta. Prevalence and role as independent predictor of cerebrovascular events in cardiac patients. Stroke 1994, 25:2010–2016.PubMedGoogle Scholar
  10. 10.
    The French Study of Aortic Plaques in Stroke Group: Atherosclerotic disease of the aortic arch as a risk factor for reccurrent ischemic stroke. N Engl J Med 1996, 334:1216–1221.Google Scholar
  11. 11.
    Tunick PA, Rosenzweig BP, Katz ES, et al.: High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol 1994, 23:1085–1090.PubMedCrossRefGoogle Scholar
  12. 12.
    Mitusch R, Doherty C, Wucherpfennig H, et al.: Vascular events during follow-up in patients with aortic arch atherosclerosis. Stroke 1997, 28:36–39.PubMedGoogle Scholar
  13. 13.
    Dávila-Román V, Murphy SF, Nickerson NJ, et al.: Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality. J Am Coll Cardiol 1999, 33:1308–1316.PubMedCrossRefGoogle Scholar
  14. 14.
    Macleod MR, Amarenco P, Davis SM, Donnan GA: Atheroma of the aortic arch: an important and poorly recognised factor in the aetiology of stroke. Lancet Neurol 2004, 3:408–414.PubMedCrossRefGoogle Scholar
  15. 15.
    Cohen A, Tzourio C, Bertrand B, et al.; on behalf of the FAPS Investigators: Aortic plaque morphology and vascular events. A follow-up study in patients with ischemic stroke. Circulation 1997, 96:3838–3841.PubMedGoogle Scholar
  16. 16.
    Tunick PA, Nayar AC, Goodkin GM, et al.; for the NYU Atheroma Group: Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque. Am J Cardiol 2002, 90:1320–1325.PubMedCrossRefGoogle Scholar
  17. 17.
    The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group: A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. Ann Neurol 1997, 42:857–865.Google Scholar
  18. 18.
    Mohr JP, Thompson JL, Lazar RM, et al.; for the Warfarin-Aspirin Recurrent Stroke Study Group: A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001, 345:1444–1451.PubMedCrossRefGoogle Scholar
  19. 19.
    Petty GW, Brown RD Jr, Whisnant JP, et al.: Frequency of major complications of aspirin, warfarin, and intravenous heparin for secondary stroke prevention. A population-based study. Ann Intern Med 1999, 130:14–22.PubMedGoogle Scholar
  20. 20.
    CAPRIE Steering Committee: A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996, 348:1329–1339.Google Scholar
  21. 21.
    Harker LA, Marzec UM, Kelly AB, et al.: Clopidogrel inhibition of stent, graft, and vascular thrombogenesis with antithrombotic enhancement by aspirin in nonhuman primates. Circulation 1998, 98:2461–2469.PubMedGoogle Scholar
  22. 22.
    Steinhubl SR, Berger PB, Mann JT, et al.; for the CREDO Investigators: Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention. A randomized controlled trial. JAMA 2002, 288:2411–2420.PubMedCrossRefGoogle Scholar
  23. 23.
    The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators: Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001, 345:494–502.Google Scholar
  24. 24.
    Bhatt DL, Fox KA, Hacke W, et al.; for the CHARISMA Investigators: Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006, In press.Google Scholar
  25. 25.
    Diener HC, Bogousslavsky J, Brass LM, et al.; on the behalf of the MATCH Investigators: Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomized, double-blind, placebo-controlled trial. Lancet 2004, 364:331–337.PubMedCrossRefGoogle Scholar
  26. 26.
    Amarenco P, Donnan GA: Should the MATCH results be extrapolated to all stroke patients and affect on-going trials evaluating clopidogrel plus aspirin? Stroke 2004, 35:2606–2608.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • Pierre Amarenco
    • 1
  • Joachim Röther
  • Patrik Michel
  • Steven M. Davis
  • Geoffrey A. Donnan
  1. 1.Department of Neurology and Stroke CentreBichat HospitalParisFrance

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