Abstract 3401: Characterization of the Infarct Pattern Caused By Complex Aortic Arch Atheroma: DWI and Multi-detector Row CT study

Abstract

Background: Aortic arch atheroma (AAA) has been accepted as a possbile embolic source in patients with ischemic stroke, especially cryptogenic stroke. In this study, we aimed to evaluate clinical and radiological characteristics including lesion pattern on DWI in acute stroke patients associated with complex AAA detected by multidetector row computed tomography (MDCT). Methods: Form September 2008 through May 2011, patients who were presented with acute ischemic stroke and underwent MDCT were found in a prospective stroke registry. Patients without evident stroke etiology were included and classified by presence of complex AAA. Complex AAA was defined as at least 6 mm thick adjacent to the aortic wall, ulcerated plaque, or vulnerable plaque. The characteristics of DWI lesions were analyzed in terms of the number and size of the lesions, and the involved vascular territories Results: A total of 62 cryptogenic stroke patients were included in this study. The complex AAA was observed in 14 (22.6%) patients. The patients with complex AAA were older than those with no/simple AAA. There were no differences between groups in terms of vascular risk factors, laboratory findings, and pre-stroke medication. DWI analysis revealed that complex AAA group had a more chance to have multiple and small lesions in multiple vascular territories that mainly located in cortical and border-zone regions than no/simple AAA group ( Figure ). Multiple logistric regression analysis showed that age (OR 1.17; 95% CI 1.02-1.40) and multiple small lesions in multiple vascular territories (OR 31.32; 95% CI 3.99-245.67) were independently associated with the complex AAA. Conclusion: The results of DWI pattern analysis indicate that complex AAA demonstrated by MDCT is associated with multiple small scattered lesions in multiple vascular territories. Figure . Summation map of all patient’ diffusion-weighted imaging in patients with complex aortic arch atheroma. The majority of lesions are small and located in cortical and border-zone regions.