Population-based study of the relationship between atherosclerotic aortic debris and cerebrovascular ischemic events.

OBJECTIVE To assess the validity of the suggestion that protruding atheromatous material in the thoracic aorta is an important cause of cerebrovascular ischemic events (CIEs) (ie, transient ischemic attack or ischemic stroke). METHODS This case-control study of Olmsted County, Minnesota, residents who underwent transesophageal echocardiography (TEE) from 1993 to 1997 included controls without CIE randomly selected from the population, controls without CIE referred for TEE because of cardiac disease, cases with incident CIE of obvious cause (noncryptogenic), and cases with incident CIE of uncertain cause (cryptogenic). RESULTS Of the 1135 subjects, 520 were randomly selected controls without CIE, 329 were controls without CIE referred for TEE, 159 were noncryptogenic CIE cases, and 127 were cryptogenic CIE cases. Complex atherosclerotic aortic debris in ascending and transverse segments of the arch was detected in 8 randomly selected controls (1.5%), 13 referred controls (4.0%), and 15 noncryptogenic (9.4%) and 4 cryptogenic (3.1%) CIE cases. After adjusting for age, sex, hypertension, smoking, atrial fibrillation, valvular heart disease, congestive heart failure, and atherosclerosis other than in the thoracic aorta, complex atherosclerotic aortic debris was not significantly associated with group status. With randomly selected controls as the referent group, odds ratios (95% confidence intervals) were 1.72 (0.61-4.87) for referred controls, 3.16 (1.18-8.51) for noncryptogenic CIE cases, and 1.39 (0.39-4.88) for cryptogenic CIE cases. CONCLUSIONS Complex atherosclerotic aortic debris is not a risk factor for cryptogenic ischemic stroke or transient ischemic attack but is a marker for generalized atherosclerosis and well-established atherosclerotic and cardioembolic mechanisms of cerebral ischemia. Embolization from the aorta is not a common mechanism of ischemic stroke or transient ischemic attack.

[1]  W. O'Fallon,et al.  Population-based study of the relationship between patent foramen ovale and cerebrovascular ischemic events. , 2006, Mayo Clinic proceedings.

[2]  D. Wiebers,et al.  Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. , 2004, Journal of the American College of Cardiology.

[3]  H. Oe,et al.  Aortic Arch Atherosclerotic Lesions and the Recurrence of Ischemic Stroke , 2004, Stroke.

[4]  G. Donnan,et al.  Aortic source of brain embolism , 2003, Current treatment options in cardiovascular medicine.

[5]  J. Seward,et al.  Comparison of frequency of patent foramen ovale by transesophageal echocardiography in patients with cerebral ischemic events versus in subjects in the general population. , 2001, The American journal of cardiology.

[6]  W. O'Fallon,et al.  Predictors of Cerebrovascular Events and Death Among Patients With Valvular Heart Disease: A Population-Based Study , 2000, Stroke.

[7]  A. Pancioli,et al.  Incidence rates of first-ever ischemic stroke subtypes among blacks: a population-based study. , 1999, Stroke.

[8]  W M O'Fallon,et al.  Ischemic stroke subtypes: a population-based study of incidence and risk factors. , 1999, Stroke.

[9]  M. Enriquez-Sarano,et al.  Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke Prevention: Assessment of Risk in a Community. , 1999, Mayo Clinic proceedings.

[10]  K. Bailey,et al.  Detection and control of high blood pressure in the community : Do we need a wake-up call? , 1999, Hypertension.

[11]  J. Seward,et al.  Frequency of atrial septal aneurysms in patients with cerebral ischemic events. , 1999, Circulation.

[12]  W. O'Fallon,et al.  Survival and recurrence after first cerebral infarction , 1998, Neurology.

[13]  P. Amarenco,et al.  An update on aortic causes of ischemic stroke , 1997, Current opinion in neurology.

[14]  B. Norrving,et al.  Cardiac changes in stroke patients and controls evaluated with transoesophageal echocardiography. , 1997, Scandinavian cardiovascular journal : SCJ.

[15]  R. Sacco,et al.  Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. , 1996, The New England journal of medicine.

[16]  R. Sacco,et al.  Aortic atheromas and acute ischemic stroke , 1996, Neurology.

[17]  W M O'Fallon,et al.  Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. , 1996, Stroke.

[18]  L. Melton,et al.  History of the Rochester Epidemiology Project. , 1996, Mayo Clinic proceedings.

[19]  A. Tonkin,et al.  Proximal aortic atheroma. An independent risk factor for cerebral ischemia. , 1995, Stroke.

[20]  W. O'Fallon,et al.  Risk of stroke with mitral valve prolapse in population-based cohort study. , 1995, Stroke.

[21]  Kistler Jp.  The Risk of Embolic Stroke -- Another Piece of the Puzzle , 1994 .

[22]  M. Hommel,et al.  Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. , 1994, The New England journal of medicine.

[23]  J. Broderick,et al.  Relationship of Cardiac Disease to Stroke Occurrence, Recurrence, and Mortality , 1992, Stroke.

[24]  C. Duyckaerts,et al.  The prevalence of ulcerated plaques in the aortic arch in patients with stroke. , 1992, The New England journal of medicine.

[25]  B K Khandheria,et al.  Biplanar transesophageal echocardiography: anatomic correlations, image orientation, and clinical applications. , 1990, Mayo Clinic proceedings.

[26]  L. Melton,et al.  Comparison of case ascertainment by medical record linkage and cohort follow-up to determine incidence rates for transient ischemic attacks and stroke. , 1990, Journal of clinical epidemiology.

[27]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[28]  P. Wolf,et al.  The Pilot Stroke Data Bank: Definition, Design, and Data , 1984, Stroke.

[29]  D. Sackett.  Bias in analytic research. , 1979, Journal of chronic diseases.