Abstract WP166: The Correlation of Proximal Complex Aortic Plaque and Possible Symptomatic Cervicocephalic Atherosclerotic Stenosis

Abstract

Background and Purpose: Complex aortic plaque (CAP) in the proximal thoracic aorta can be an embolic source for acute ischemic cerebrovascular disease (AICVD), while culprit cervicocephalic atherosclerotic stenosis may coexist. However, the associations between proximal CAP and possible symptomatic cervicocephalic atherosclerotic stenosis (PS-CAS) remain unclear. We aimed at testing whether CAP tended to distribute in the proximal thoracic aorta in AICVD patients with PS-CAS, offering potential risk of aortogenic cerebral embolism. Methods: Patients ≥45 years old with AICVD were consecutively enrolled and underwent CT angiography of cervicocephalic arteries and thoracic aorta. Thoracic aorta was divided into proximal and distal parts by the ostium of the left subclavian. Plaques with thickness ≥4 mm, associated ulcer or mural thrombus were considered to be CAP. Distributing patterns of CAP in the thoracic aorta included proximal only (PO), distal only (DO) and proximal + distal (PD). Extracranial and intracranial atherosclerotic stenosis which could be the potential cause of the cerebral ischemia with luminal stenosis ≥50% was defined as PS-CAS. Results: Within 285 patients with AICVD, 55 had CAP-PO (19.3%), 37 had CAP-DO (13.0%), 72 had CAP-PD (25.3%). Extracranial and intracranial PS-CAS were detected in 62 and 143 patients (21.8% and 50.2%) respectively. AICVD patients with PS-CAS were more likely to have CAP-PO and CAP-PD than those without (51.9% vs. 35.2%, p=0.005). Regardless of age, sex and vascular risk factors, CAP-PO was associated with extracranial PS-CAS (adjusted OR=5.39, 95%CI: 2.18-13.36) and intracranial PS-CAS (adjusted OR=2.59, 95%CI: 1.25-5.38), whereas CAP-DO bored no relationship with them. CAP-PD was independently related to extracranial PS-CAS (adjusted OR=6.59, 95%CI: 2.53-17.15) but not intracranial PS-CAS. Conclusions: AICVD patients with PS-CAS were more likely to have CAP in the proximal thoracic aorta. The risk of potential aortogenic cerebral embolism might be higher when PS-CAS, especially the extracranial ones, was identified in patients with AICVD.