Aortic Arch Atheroma Research Articles

Periodontal Disease Associated with Aortic Arch Atheroma in Patients with Stroke or Transient Ischemic Attack

Periodontal disease (PD) is associated with recurrent vascular event in stroke or transient ischemic attack (TIA). In this study, we investigated whether PD is independently associated with aortic arch atheroma (AA). We also explored the relationship PD has with AA plaque thickness and other characteristics associated with atheroembolic risk among patients with stroke or TIA. Finally, we confirmed the association between AA and recurrent vascular event in patients with stroke or TIA. In this prospective longitudinal hospital-based cohort study, PD was assessed in patients with stroke and TIA. Patients with confirmed stroke and TIA (n = 106) were assessed by calibrated dental examiners to determine periodontal status and were followed over a median of 24 months for recurrent vascular events (stroke, myocardial infarction, and death). The extent of AA and other plaque characteristics was assessed by transesophageal echocardiography. Within our patient cohort, 27 of the 106 participants had recurrent vascular events (including 16 with stroke or TIA) over the median of 24-month follow-up. Severe PD was associated with increased AA plaque thickness and calcification. The results suggest that PD may be a risk factor for AA. In this cohort, we confirm the association of severe AA with recurrent vascular events. In patients with stroke or TIA, severe PD is associated with increased AA plaque thickness, a risk factor for recurrent events. Further studies are needed to confirm this finding and to determine whether treatment of PD can reduce the rate of AA plaque progression and recurrent vascular events.

Abstract 422: Protease-Activated Receptor 2 is Critical for the Formation and Progression of Atherosclerosis

Objective: Protease-activated receptor 2 (PAR-2)-dependent signaling results in augmented inflammation and has been implicated in the pathogenesis of several autoimmune conditions. While PAR-2 protein is present in coronary atherosclerotic lesions, the relevance of this finding has not been investigated in experimental models. The objective of this study was to determine the effects of PAR-2 on the development of atherosclerosis. Methods and Results: Relative expression of PAR-2 is increased in human coronary artery (21 fold) and mouse aortic arch (16 fold) atheromas versus control coronary and aortic arch arteries, respectively (P = 0.001). To determine the effect of PAR-2 deficiency on atherosclerosis, male low density lipoprotein receptor deficient ( Ldlr -/- ) mice (8-12 weeks old) that were Par-2 +/+ or Par-2 -/- were fed a fat and cholesterol-enriched diet for 12 (n = 10 each group) or 24 weeks (n = 5 each group). PAR-2 deficiency attenuated atherosclerosis in the aortic sinus and aortic root with no effects on total plasma cholesterol concentrations or lipoprotein distributions after 12 (P = 0.000433) and 24 (P = 0.037) weeks. These reductions were attributable to both hematopoietic and non-hematopoietic-derived PAR-2 from analysis of bone marrow experiments (n = 15 for each of 4 chimeric groups; P < 0.05). Mechanistic studies using ex vivo macrophages show that activation of PAR-2 results in augmented foam cell formation and apoptosis with treatment of oxidized low-density lipoprotein in conjunction with decreased expression of the nuclear receptor LXR-alpha and several cholesterol transporters. In addition, PAR-2 activation of ex-vivo cultured vascular smooth muscle cells (VSMCs) augments their transition to a macrophage-like state (after cholesterol treatment) via upregulation of human antigen R (HuR) and resultant stabilization of the transcription factor Krüppel-like factor 4 (KLF4). Conclusion: Our results indicate PAR-2 deficiency significantly attenuates the initiation (12 weeks) and reduces the progression (24 weeks) of atherosclerosis potentially via regulation of both lipid efflux from macrophages and the phenotypic modulation of VSMCs.

Pathogenesis and Risk Factors for Cerebral Infarct After Surgical Aortic Valve Replacement.

Stroke is a potentially devastating complication of cardiac surgery. Identifying predictors of radiographic infarct may lead to improved stroke prevention for surgical patients. We reviewed 129 postoperative brain magnetic resonance imagings from a prospective study of patients undergoing surgical aortic valve replacement. Acute infarcts were classified as watershed or embolic using prespecified criteria. Acute infarct on magnetic resonance imaging was seen in 79 of 129 patients (61%), and interrater reliability for stroke pathogenesis was high (κ=0.93). Embolic infarcts only were identified in 60 patients (46%), watershed only in 2 (2%), and both in 17 (13%). In multivariable logistic regression, embolic infarct was associated with aortic arch atheroma (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.0-12.0; P=0.055), old subcortical infarcts (OR, 5.5; 95% CI, 1.1-26.6; P=0.04), no history of percutaneous transluminal coronary angioplasty or coronary artery bypass graft (OR, 4.0; 95% CI, 1.2-13.7; P=0.03), and higher aortic valve gradient (OR, 1.3 per 5 mm Hg; 95% CI, 1.09-1.6; P=0.004). Watershed infarct was associated with internal carotid artery stenosis ≥70% (OR, 11.7; 95% CI, 1.8-76.8; P=0.01) and increased left ventricular ejection fraction (OR, 1.6 per 5% increase; 95% CI, 1.08-2.4; P=0.02). The principal mechanism of acute cerebral infarction after aortic valve replacement is embolism. There are distinct factors associated with watershed and embolic infarct, some of which may be modifiable.

An Approach to Working Up Cases of Embolic Stroke of Undetermined Source.

BackgroundFrom a therapeutic viewpoint, it is important to differentiate the underlying causes of embolism in patients with cryptogenic stroke, such as aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. We investigated the clinical and radiological characteristics of these 3 common causes of cryptogenic embolism to develop models for decision making in etiologic workups.Methods and ResultsA total of 321 consecutive patients with acute infarcts from cryptogenic embolism were included. Patients were divided into 3 groups—aortic arch atheroma (n=40), patent foramen ovale (n=153), and paroxysmal atrial fibrillation (n=128)—based on extensive cardiologic workups. We used a multinomial logistic regression analysis to detect the clinical and diffusion‐weighted imaging factors associated with the probability of aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. Clinical and radiological features differed among the groups. The patent foramen ovale group had a healthy vascular risk factor profile and showed posterior circulation involvement compared with other groups (P<0.01). In contrast, paroxysmal atrial fibrillation–related strokes had higher initial National Institutes of Health Stroke Scale (NIHSS) scores and larger lesions than the other groups (P<0.001). The aortic arch atheroma group had clinical features similar to those of the paroxysmal atrial fibrillation group but showed small lesions scattered in multiple vascular territories (P<0.001). Multivariate regression analysis revealed that age, initial NIHSS score, lesion size (≥20 mm), multiple (≥3) lesions, and involvement of posterior circulation or multiple vascular territories differentiated the 3 groups (pseudo, R 2=0.656). The prediction ability of this model was validated in the external validation cohort (n=117, area under the curve 0.78).ConclusionsOur data indicate that patients with cryptogenic embolic stroke show distinct clinical and radiological features depending on the underlying causes.

Airplane stroke syndrome

Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism.

Abstract WP216: Stroke Recurrence in Patients With Cryptogenic Stroke

Background &amp; Purpose: In cryptogenic stroke or transient ischemic attack (TIA) patients, aortic arch atheroma or patent foramen ovale (PFO) evaluated by using transesophageal echocardiography (TEE) is well known as possible embolic source. These findings were sometimes associated with stroke recurrence. We investigated predictive factors for stroke recurrence in patients with cryptogenic stroke. Methods: From February 2008 to December 2013, among 1832 consecutive stroke or TIA patients, 315 patients (male, 57.8%; age, 73.3±10.9) who were admitted within 7 days after the symptom onset without both atrial fibrillation and significant stenosis (50% or more in diameter) in the cerebral arteries underwent TEE for evaluating embolic sources; embolism was the probable etiological mechanism for their event. Patients with malignancy, cerebral arterial dissection, or infarcts in the perforating artery territory were excluded. We observed stroke recurrence during one year and investigated predictive factors for stroke recurrence. Results: In TEE, spontaneous echo contrast in the left atrium, aortic arch atheroma of 4.0 mm or more in thickness (mean, 4.65±2.06 mm), PFO, and pulmonary arteriovenous fistula were observed in 24 (7.6%), 223 (70.3%), 26 (8.2%), and 20 (6.3%) patients, respectively. Stroke recurrence was observed in 39 (12.4%) patients. Aortic arch atheroma of 4.0 mm or more, male, and prior hemorrhagic stroke were more frequent, and the initial diastolic blood pressure (DBP) and HbA1c were higher in patients with than without stroke recurrence. On the multivariate analysis using those factors and age, aortic arch atheroma (OR 3.73, 95%CI 1.46–11.7) and the initial DBP (OR 1.03, 95%CI 1.00–1.05) were positive predictors for a stroke recurrence. With regard to the operating characteristic curve analysis, the most accurate cut off values for a stroke recurrence were 4.1mm (AUC 0.59) in aortic arch atheroma thickness and 91mmHg in DBP (AUC 0.58). Conclusions: In acute cryptogenic stroke, aortic arch atheroma was observed frequently. Aortic arch atheroma and DBP were significantly associated with one-year stroke recurrence. TEE was required for evaluating aortic arch atheroma in patients with cryptogenic stroke

ネフローゼ症候群に脳梗塞を合併し左心房内もやもやエコーと大動脈弓部粥腫を有した2 例

ネフローゼ症候群に脳梗塞を合併し左心房内もやもやエコーと大動脈弓部粥腫を有した2 例

Association of Dietary Factors with Progression of AA in Stroke/TIA Patients.

To investigate the effect of dietary factors such as calorie intake and dietary fats on the progression of aortic arch atheroma (AA). In stroke/TIA patients, progression of AA is associated with recurrent vascular events. Consecutive patients with measurable (>1 mm) AA atheroma on baseline transesophageal echocardiogram (TEE) evaluation consented to a protocol mandated follow-up TEE at 12 months. Patients that had adequate paired AA images were assessed for progression, defined as Δ ≥ 1 grade worsening (based on plaque thickness over 12 months). Stroke risk factors and fasting lipid profile were assessed at baseline. The patient's nutritional intake was measured at baseline using the Gladys Block Food Frequency Questionnaire. One-hundred-nine patients (70 strokes, 33 TIAs) had sequential TEEs, of whom 27% (N=30) progressed and 73% (N=79) did not. Patients with progression had higher daily calorie (1778 ± 623 vs. 1378 ± 406 Calories, p=0.008), fat (76 ± 33 vs. 52 ± 23 grams, p=0.0002), carbohydrate (208 ± 78 vs. 169 ± 57 grams, p=0.01) and protein (73 ± 26 vs. 57 ± 21 grams, p=0.005) intake. On Further analysis among different fats showed a higher consumption of saturated fats (25 ± 12 vs. 17 ±8 grams, p=0.00051) as well as unsaturated fats (44 ± 20 vs. 30 ± 13 grams, p=0.002). These differences remained significant after we adjusted for the medication use. However the significance of these differences was attenuated after adjusting for the calorie intake. Cholesterol consumption did not differ between the progression and no-progression group (262 ± 125 vs. 213 ± 149 mg, p=0.2). Calorie intake plays a significant role in the progression of AA. Further studies are needed to confirm these findings and determine the specific dietary modifications that may prevent AA progression and associated recurrent vascular events.

Effect of stroke prevention medication on aortic atheroma progression assessed using new statistical paradigm

Abstract Background: Progression of aortic arch atheroma (AA) is associated with vascular events in patients with stroke or transient ischemic attack (TIA). Studies investigating effect of stroke prevention

The diagnostic yield of transesophageal echocardiography in patients with cryptogenic cerebral ischaemia: a meta‐analysis

The diagnostic utility of transesophageal echocardiography (TEE) in patients with cryptogenic ischaemic stroke (IS) or transient ischaemic attack (TIA) remains controversial. A systematic review and meta-analysis was performed according to PRISMA guidelines to estimate the pooled prevalence of potential cardioembolic causes detected by TEE in prospective observational studies of cryptogenic IS/TIA. Cardiac conditions causally associated with cerebral ischaemia were considered to be intramural thrombi and intracardiac tumors according to ASCO phenotyping of IS. Thirty-five eligible studies, comprising 5772 patients (mean age 53.6 years, 56.9% men) were identified. The most common TEE finding was ascending aorta and/or aortic arch atheroma [51.2% (27.4%-74.5%)], followed by patent foramen ovale (PFO) [43.2% (36.3%-50.4%)]. Complex aortic plaques and large PFOs were reported in 14% (10.2%-18.9%) and 19.5% (16.6%-22.8%) of TEE evaluations. The prevalence of atrial septal aneurysm was 12.3% (7.9%-18.7%) and was significantly higher in conjunction with PFO presence (risk ratio 2.04, 95% confidence interval 1.63-2.54, P < 0.001). The prevalence of left atrial thrombus [3.0% (1.1%-8.3%)] and spontaneous echo contrast [3.8% (2.3%-6.2%)] was low. The prevalence of intracardiac tumors was extremely uncommon [0.2% (0%-0.7%)]. Significant heterogeneity was identified (I(2) > 60%) in the majority of analyses. Heterogeneity was not affected by cryptogenic stroke definition (TOAST versus alternative criteria). After dichotomizing available studies using a cut-off of 50 years, PFO was significantly (P = 0.001) more prevalent in younger than in older patients. Routine TEE in patients with cryptogenic IS/TIA commonly identifies abnormal findings. However, the prevalence of cardiac conditions considered to be causally associated with cerebral ischaemia (intracardiac thrombi and tumors) is low.

Abstract 18462: Hickam's Dictum Revisited: A Multifactorial Etiology of Stroke in a Patient With Rheumatic Mitral Stenosis and Atrial Septal Aneurysm

A 64-year-old gentleman with rheumatic mitral stenosis (MS), coronary artery disease, and active tobacco abuse was admitted with a left posterior cerebral artery (PCA) territory ischemic cerebrovascular accident (CVA). He presented with confusion, headaches, and alexia with stable vital signs. He denied rest or exertional dyspnea. Physical exam revealed right homonymous hemianopia, mild right upper extremity dysmetria, decreased right facial sensation, and mild prosopagnosia. Initial neuroimaging confirmed an evolving left hemispheric infarct. Laboratory testing showed unremarkable inflammatory markers. Computed tomographic (CTA) and magnetic resonance angiography (MRA) of the head and neck confirmed left PCA territory acute or subacute infarction with occlusion of the left P2 segment. 12-lead electrocardiogram demonstrated normal sinus rhythm. Occult atrial fibrillation was not seen. Transthoracic echocardiogram (TTE) showed no evidence of right-to-left interatrial shunt. Moderate left atrial (LA) dilation, posterior mitral leaflet tip calcification, and a resting mean mitral gradient of 20 millimeters of mercury (mmHg) suggested severe mitral stenosis. Given the discrepancy between the patient’s symptoms and the TTE findings, transesophageal echocardiogram (TEE) was performed (Figure). The patient’s left PCA territory infarct was ascribed to multifactorial cardioembolic etiologies: 1) Atrial septal aneurysm (ASA) 2) Rheumatic MS and 3) Aortic arch atheroma. Anticoagulation was recommended and initiated 14 days after his CVA to minimize risk of hemorrhagic transformation. High-dose atorvastatin and aspirin were instituted. He progressed well through rehabilitation, demonstrating steady neurological improvement. The case underscores the importance of pursuing further investigation when discrepancies exist between clinical and objective data. ASA is an uncommon but under-recognized risk factor for cardioembolic stroke.

Identifying suspected ruptured aortic arch atheroma in acute ischemic stroke by 18 F-sodium fluoride positron emission tomography-computed tomography

Identifying suspected ruptured aortic arch atheroma in acute ischemic stroke by 18 F-sodium fluoride positron emission tomography-computed tomography

Complex Atheromatosis of the Aortic Arch: An Emerging Diagnosis in Cerebral Ischemia of Unknown Cause

Complex atheromatosis of the aortic arch has been increasignly recognized as a cause of cerebral infarction in patients with stroke of uncertain etiology. The incorporation of transesophageal echocardiographic studies in routine clinical practice allows direct visualization of cardiac and vascular structures previously innaccessible, including atherosclerotic plaques in the aortic arch. Large atheromatous plaques, which protrude strikingly into the aortic arch lumen and have obvious mobile components are associated with a high probability of being the etiology of embolism. Aortic arch atheromatosis should be considered a dynamic process entailing a non-negligible risk of recurrent cardiovascular events. Therefore, adequate diagnosis and optimal treatment is mandatory for secondary prevention of cerebral ischemic infarction and progression of aortic arch atheromas.

Abstract T MP60: Impact of Aortic Arch Atheroma for Stroke Recurrence in Patients With or Without Atrial Fibrillation

Background &amp; Purpose: In patients with embolic stroke of undetermined source, aortic arch atheroma evaluated using transesophageal echocardiography (TEE) is a possible embolic source. We investigated the impact of embolic sources including aortic arch atheroma for a stroke recurrences and death. Methods: Among the consecutive 1545 acute stroke patients, 542 patients who were admitted within 24 hours after the symptom onset, with ischemic lesions in the cortex or cerebellum on the diffusion-weighted image, NIH stroke scale of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. All 542 patients underwent TEE to search for embolic sources. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for average period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources. Results: Stroke recurrences were observed in 12.0% patients in group A, 11.8% patients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recurrence-free survival among the four groups (p=0.0076, log-rank test). Stroke recurrence was more frequent in group B than group C patients especially in the early phase from the onset. On COX proportional-hazards model analysis and diabetes mellitus (HR 1.73, p=0.0264) and aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146) were significant predictors for stroke recurrences and death from any cause. Conclusions: Severe aortic arch atheroma can independently be associated with stroke recurrences and death, furthermore, a combination of aortic arch atheroma and cardiogenic embolic sources showed more frequent events than each of them alone.

Abstract W P371: Periodontal Disease is Associated with Aortic Arch Atheroma a Marker of Recurrent Vascular Events in Stroke/TIA Patients

Background: Periodontal disease (PD) is independently associated with recurrent vascular events in Stroke/TIA. Aortic arch atheroma (AA) is an independent risk factor for stroke. The association between PD and AA has not been described. Objective: To test the association between: 1) significant AA and recurrent vascular event in stroke/TIA 2) PD and AA (plaque severity and characteristics) Methods: In this prospective longitudinal hospital-based cohort study, PD was assessed in Stroke/TIA patients. Based on clinical measures patients were classified to have high (HPD) versus low periodontal disease (LPD). As part of their stroke work-up, AA was assessed using transesophageal echocardiogram (TEE). Based on plaque thickness the AA was graded as mild (0-0.99 mm), moderate (1-3.99 mm) or severe (≥4 mm), as well as plaque characteristics, namely mobility, ulceration and calcification. The patients were followed up for recurrent vascular events, namely stroke, TIA, myocardial infarction and vascular death. Results: In an eighteen-month period, 106 patients were evaluated, 40(38%) showed HPD and 27 (26%) had recurrent vascular events over a median of 24 months (range 12-24 months). AA assessed by TEE revealed 16 with mild, 73 with moderate, and 17 with severe plaque. Those with severe AA had a higher rate of recurrent vascular event compared to those without (Figure). Severe AA was associated with recurrent vascular events (HR 2.3, 95% CI, 1.02-5.32). HPD patients had higher (p = 0.004) AA plaque thickness (Mean±SD 2.0±2.4 mm) compared with LPD (1.6±1.2 mm). HPD was associated with moderate AA (OR 10.5, 95% CI, 1.3-84) and severe AA (OR 16.9, 95% CI, 1.8-158). Among plaque characteristics HPD was associated (p=0.02) with calcification. Conclusion: In stroke/TIA patients severe AA is associated with recurrent vascular events. HPD is associated with an increased AA plaque thickness and calcification. The results suggest that PD may be a risk factor for AA.

Cardiological aspects of stroke prevention.

Many cardiac disorders and their treatment are associated with an increased risk for ischemic or hemorrhagic stroke, so it is important for cardiologists to be aware of recent advances in the field of stroke prevention. Atrial fibrillation (AF) is the most common cardiac disorder associated with a substantial risk for ischemic stroke (IS). The availability of implantable cardiac monitoring devices has substantially increased the detection rate of occult AF after IS. The 4 new oral anticoagulants have advantages when compared with warfarin, the standard therapy in AF to prevent IS, demonstrating a reduced risk for IS or intracerebral hemorrhage. Patients with cardiomyopathy, cardiac valve replacement, recent myocardial infarction, larger aortic arch atheroma and patent foramen ovale all have some level of increased risk for IS. The best approach for IS prevention in these disorders remains unsettled and varying approaches are recommended.

Impact of Transesophageal Echocardiography on Management in Patients With Suspected Cardioembolic Stroke

Transesophageal echocardiography (TEE) is frequently performed in patients with acute ischemic cerebrovascular events to exclude a cardioembolic source. We aimed to determine the clinical impact of TEE on management. This is a retrospective single-center study of 1,458 consecutive patients hospitalized with acute ischemic stroke or transient ischemic attack who underwent TEE for evaluation of a suspected cardioembolic cause. Significant TEE findings were determined for each patient as recorded on the TEE report. The medical record was reviewed for baseline, clinical, and demographic variables and to determine whether significant management changes occurred as a result of the TEE findings. Potential significant changes in management included initiation of anticoagulation, placement of a patent foramen ovale (PFO) closure device, initiation of antibiotic therapy for endocarditis, surgical PFO closure, other cardiac surgery, and coil embolization of a pulmonary arteriovenous malformation. A significant change in management occurred in 243 patients (16.7%); 173 (71%) underwent treatment for PFO with a percutaneous PFO closure device (n= 100), initiation of chronic systemic anticoagulation (n= 68), or surgical PFO closure (n= 5). Additional findings leading to achange in management included endocarditis (n= 20), aortic arch atheroma (n=14), intracardiac thrombus (n= 13), pulmonary arteriovenous malformation (n= 2), aortic valve fibroelastoma (n= 2), other valve masses (n= 4), and miscellaneous causes (n= 15). In conclusion, in patients with suspected cardioembolic stroke, TEE findings led to a change in management in 16.7% of patients. Of these, most (71%) were directed at prevention of subsequent paradoxical emboli in patients with PFO.

Aortic arch atheroma and the risk of stroke: a meta-analysis.

Epidemiological studies have suggested that aortic atheroma may play a role in cerebral embolization; however, no meta-analysis was conducted to evaluate the relationship between aortic atheroma and risk of stroke. The aim of this study was to investigate the association between the presence of aortic atheroma and risk of stroke. We performed a comprehensive search of observational studies reporting the relationship between the presence of aortic atheroma and stroke using the PubMed, EMbase, the China National Knowledge Infrastructure database (CNKI), Chinese Technical Periodicals (VIP), and WanFang Data databases. Two reviewers independently assessed the eligibility and extracted data from the included studies. We performed the meta-analysis to estimate the strength of the association according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline and assessed the study quality by the Newcastle-Ottawa Scale (NOS). We identified 12 eligible studies with 3918 participants. The scores of the NOS of the included studies ranged from 5 to 9. The pooled estimate of strength of the association between the presence of aortic atheroma and stroke was statistical significant (OR = 3.93, 95%CI 2.86 to 5.40). In subgroup analysis according to plaques' morphology, complex aortic atheroma had significantly higher (OR = 5.90, 95%CI 4.14 to 8.41) risk of stroke than protruding atheroma (OR = 3.75, 95%CI 3.05 to 4.61). This study indicated that aortic atheroma significantly increased the risk of stroke by about four times. Patients with complex aortic atheroma have a higher risk of stroke than protruding atheroma.

Abstract 24: Predictors of Occult Atrial Fibrillation in Cryptogenic Stroke

Background and Purpose: Prolonged cardiac monitoring may identify paroxysmal atrial fibrillation (AF) in patients with cryptogenic stroke. We aimed to identify clinical, echocardiographic, and neuroimaging features which may increase the efficiency of detecting AF on cardiac monitoring. Methods: We studied a retrospective cohort of 227 subjects with cryptogenic ischemic stroke referred for 28 day mobile cardiac outpatient telemetry (MCOT). Patients with large artery disease or high risk sources of cardioembolism were excluded. We reviewed medical records, brain images, and echocardiograms, blinded to MCOT results. Acute and/or chronic infarctions were characterized by size, location, and as cortical, subcortical, or both; wedge-shaped; lacunar; borderzone; and/or multiple territories. Cardiac features included left atrial (LA) size, ejection fraction, aortic arch atheroma, and PFO. Variables were tested in univariate analyses and further incorporated in a multivariate logistic regression model to determine independent predictors of detecting AF. Results: The cohort age was 62.9±2.9 years, 42% were men, and 53% were white. Median CHADS was 3 and CHADS2Vasc was 5. Infarcts were &gt;1.5 cm in 62% of subjects, predominantly cortical in 47%, subcortical in 39%. Only 9% were single, deep, and &lt;1.5 cm. LA size was 3.6±0.7 cm and ejection fraction was 61±9%. MCOT detected AF in 30 (13%) patients. In multivariate analysis, AF was only associated with age&gt;60 (OR 3.6 [1.2-10.4], p=0.02) and prior (chronic) cortical or cerebellar infarction (OR 3.3 [1.3-8.6], p=0.013) (C-statistic 0.72). There was no association with any other clinical, echocardiographic, or radiographic parameter. AF was detected in 32% of patients with age &gt;60 and the presence of prior cortical or cerebellar infarction, compared to 4% with neither of these factors. Conclusion: Atrial fibrillation is detected on MCOT in a substantial minority of cryptogenic stroke patients. Age&gt;60 and the presence of prior cortical or cerebellar strokes are predictive of detecting AF in these patients. Other brain and cardiac characteristics were not found to be helpful. These data may aid in the selection of patients for prolonged arrhythmia monitoring.

Aortic Arch Atheroma and Further Cardiovascular Events in Stroke Patients

Aortic Arch Atheroma and Further Cardiovascular Events in Stroke Patients