Intraaortic debris as a potential source of embolic stroke

Rubin, David C.; Plotnick, Gary D.; Hawke, Mary W.

doi:10.1016/0002-9149(92)90516-2

Cited by 27 publications

(3 citation statements)

References 3 publications

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“…331,335,338,[340][341][342][343][344][345][346][347] In addition, thoracic aortic atherosclerosis has been identified as a stronger predictor of significant coronary artery disease than are conventional risk factors 348 and as a marker of increased mortality. 349 Aortic atherosclerosis has also been associated with cholesterol embolization (blue-toe syndrome), stroke after coronary artery bypass surgery, and catheter-related embolism after cardiac catheterization and intra-aortic balloon pump insertion.…”

Section: Atherosclerosismentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

545

434

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Section: Atherosclerosismentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

545

434

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“…These risk factors are similar to those of ischemic stroke [14,15,16]. Case reports separately provide evidence of brain infarction due to calcific emboli from aortic valves [17,18,19,20,21,22,23]. However, several previous studies have suggested that there is no association between aortic VaT and cerebrovascular events [24, 25].…”

Section: Discussionmentioning

confidence: 85%

Impact of Valvular Thickness on Stroke Recurrence in Medically Treated Patients with Stroke

Okajima¹,

Abe²,

Suzuki³

et al. 2007

Cerebrovasc Dis

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Background: It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke. Methods: We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates. Results: VaT was present in 57.3% of the patients (359/627), 34.6% (271/627) involving the aortic valve and 46.4% (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95% CI: 0.74–1.85; 2-year event rates: 18.9 vs. 13.2%) or mitral valve (p = 0.66; HR: 0.91; 95% CI: 0.60–1.38; 2-year event rates: 16.9 vs. 14.7%). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95% CI: 0.37–1.14, 2-year event rates: 15.2 vs. 22.7% for the aortic valve; p = 0.22, HR: 0.70, 95% CI: 0.40–1.23, 2-year event rates: 14.2 vs. 19.6% for the mitral valve). Conclusions: VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.

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“…In fact, some observational studies denied this relationship, 24,25 while others confirmed 4,26,27 . Embolism may play a role in this condition, as case reports have provided evidence of brain infarction due to calcific emboli from aortic valves 28–31 . Larger studies are required to further clarify the relationship between AVC and stroke.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve calcification predicts poor outcomes after primary percutaneous coronary intervention

Dai

Liu

Zhou

et al. 2022

Eur J Clin Investigation

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Background: Aortic valve calcification (AVC) is associated with increased cardiovascular risk in the general population. We sought to investigate whether AVC identified by transthoracic echocardiography could be a predictor of long-term adverse events after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction.Methods: Patients undergoing primary PCI were consecutively enrolled in this cohort study between 1 January 2009 and 31 December 31 2018. The presence of AVC was identified by transthoracic echocardiography one to three days after PCI. The primary endpoint was major adverse cardiovascular and cerebral events (MACCE) during follow-up. Propensity score matching was adopted to adjust for the baseline differences between groups. Results:Of 2117 patients enrolled in the study, 566 (26.7%) were found to have AVC. Patients with AVC were older, more likely to be women, and disposed to have comorbidities and complex lesions. During a median follow-up period of 6.1 years, 699 cases of MACCE occurred, including 243 (42.9%) cases in patients with AVC and 456 (29.4%) cases in patients without AVC. After 1:1 propensity score matching, the presence of AVC increased the risk of MACCE (adjusted hazard ratio: 1.442, 95% confidence interval: 1.186 to 1.754, p < 0.001). This difference persisted when sensitivity and subgroup analyses were made.Conclusions: AVC identified by transthoracic echocardiography independently increased the long-term risk of MACCE after primary PCI in patients with acute myocardial infarction. This imaging feature will contribute to better risk stratification in this population.

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Intraaortic debris as a potential source of embolic stroke

Cited by 27 publications

References 3 publications

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Impact of Valvular Thickness on Stroke Recurrence in Medically Treated Patients with Stroke

Aortic valve calcification predicts poor outcomes after primary percutaneous coronary intervention

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