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Jesse Weinberger, MD; Nikolais Papamitsakis, MD; Andre Newfield; James Godbold, PhD; Martin Goldman, MD

Arch Neurol. 2000;57:81-84.

Background  Studies of aortic arch plaques with transesophageal echocardiography have demonstrated that complex aortic arch plaques (CAPs) greater than or equal to 4 mm in thickness are associated with ischemic stroke. Recent studies have demonstrated that the morphological features of plaques may aid in the identification of aortic plaques that are more likely to be associated with embolic stroke.

Objective  To identify aortic plaques that are more likely to be associated with embolic stroke by means of their morphological features.

Methods  Transcutaneous B-mode ultrasonography was used to image aortic arch plaques in 500 consecutive patients. The criteria used to identify the morphological features of carotid artery plaques that are more likely to be associated with ischemic stroke (heterogeneous rather than homogeneous) were applied to aortic arch plaques. Statistical comparisons were made using the Fisher exact test.

Results  Ischemic symptoms (eg, stroke, transient ischemic attack, and amaurosis fugax) were present in 38% of 104 patients with CAP and in 34% of 391 patients without CAP. Nineteen (51%) of 37 patients with heterogeneous CAP were symptomatic. Twenty-one (31%) of 67 patients with homogeneous CAP were symptomatic (P = .04).

Conclusion  Transcutaneous B-mode ultrasonography of the aortic arch can help to identify heterogeneous plaques that are more likely to be associated with ischemic stroke using morphological criteria derived from studies of carotid artery plaque.

From the Departments of Neurology (Drs Weinberger and Papamitsakis and Mr Newfield) and Community Medicine (Dr Godbold) and the Cardiovascular Institute (Dr Goldman), The Mount Sinai School of Medicine, New York, NY. Dr Papamitsakis is now with the Department of Neurology, Wayne State University School of Medicine, Detroit, Mich.

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