Characteristics and predictors of aortic plaques in patients with transient ischemic attacks and strokes.

Objective: To identify the prevalence and characteristics of aortic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events.

Background: Aortic atheroma is associated with ischemic stroke. Its characteristics, including morphology and distribution among different stroke subtypes, are not well described.

Method: From July 2000 to August 2001, all patients evaluated by transesophageal echocardiography (TEE) with diagnoses of transient ischemic attacks (TIAs) and strokes were prospectively studied. Demographics, including age, gender, ethnicity, cerebrovascular risk factors, and stroke subtypes, were collected.

Results: Thoracic aortic atheromas (TAAs) were present in 141 of 237 patients (59%) (mean age = 59 +/- 14, 119 [50%] male). Mild plaque (< 2 mm) was present in 13 of 237 (5%), moderate plaque (2-4 mm) in 49 (21%), severe plaque (> or = 4 mm) in 79 (33%), and complex plaque in 64 (27%). Patients' ages (odds ratio [OR] = 1.05, confidence interval [CI] 1.03-1.08, P < .001), coronary artery disease (OR = 2.2, CI 1.02-4.8, P < .042), and patent foramen ovale (PFO) (OR = 0.39, CI 0.22-0.70, P < .002) were associated with the severity and complexity of aortic plaque. In multivariate analysis, age (OR = 1.06, CI 1.03-1.08, P < .001) and the presence of PFO (OR = 0.35, CI 0.18-0.65, P < .001) continued to be significant to the severity and complexity of aortic atheroma. Gender, history of stroke, hypertension, diabetes mellitus, hyperlipidemia, and history of smoking were not associated with TAA.

Conclusion: One third of TAA plaques are severe and complex in nature and more frequently present in the descending aorta and the arch of the aorta than in the ascending aorta. TEE should be considered for the early detection and treatment of TAA in patients without identified causes of stroke.