Kim SW, et al. - In order to assume the underlying pathophysiology, the researchers assessed lesion patterns of patients with complex aortic plaque (CAP). Small cortical lesions or subcortical single lesion were frequently found in patients who had CAP. These findings suggested that ischemic stroke in aortic atheroma patients was correlated with either small emboli or small artery disease.

Methods

• The researchers included acute ischemic stroke patients who underwent transesophageal echocardiography.
• They defined CAP as a plaque in the proximal aorta ≥ 4 mm thick or with a mobile component.
• They compared the diffusion-weighted imaging lesion patterns of patients with CAP to those with large arterial atherosclerosis (LAA) or cardioembolism (CE).

Results

• The researchers included 64 CAP patients, 127 LAA patients, and 80 CE patients.
• In the CAP group (45.3%), small cortical pattern was more common than in the LAA (7.9%, p < 0.001) or the CE group (23.8%, p=0.018).
• In the CE group, a large cortical pattern was more common than in the CAP group (p < 0.001), while subcortical only pattern tended to be more common in the CAP group than in the CE group (p=0.057).
• 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 multinominal analysis.