Is Aortic Atherothrombotic Disease Detected Using Multidetector-Row CT Associated With an Increased Risk of Early Ischemic Lesion Recurrence After Acute Ischemic Stroke?

Abstract

Background and Purpose-Multidetector-row CT (MDCT) is emerging as a new tool for diagnosing aortic atherothrombotic disease (AAD). We elucidated whether MDCT-detected AAD is associated with an increased risk of early ischemic lesion recurrence on diffusion-weighted MRI after ischemic stroke. Methods-A consecutive series of patients with acute ischemic stroke confirmed using diffusion-weighted MRI who were hospitalized within 48 hours after symptom onset and underwent MDCT were identified in a prospective stroke registry database. AAD on MDCT was defined as the presence of plaque formation that was noncalcified and Ն4 mm thick, ulcerative, or soft and thrombosed (vulnerable) in the proximal aortic arch. Ischemic lesion recurrence on diffusionweighted MRI was defined as the occurrence of any new lesion separate from the index lesion on follow-up diffusion-weighted MRI performed within 14 days after symptom onset.

Predictors of Recurrent Stroke in Patients with Ischemic Stroke: Comparison Study between Transesophageal Echocardiography and Cardiac CT

“…By using an alternate method for diagnosing aortic plaque and stroke recurrence than those in previous TEE studies, Ko et al demonstrated that aortic plaque detected with CT is associated with increased risk of early stroke recurrence after acute ischemic stroke. This supports the role of CT in the diagnosis of aortic plaque and the assessment of its contribution to recurrence (1). Another study showed that CT demonstrated more complex plaques than TEE (24).…”

“…Recurrent stroke is a major cause of mortality and morbidity in patients with stroke. It is known that recurrent stroke is frequent in patients with ischemic stroke (1,2). The origins of ischemic stroke are variable, and cardiogenic strokes represent 20%-30% of ischemic strokes (3).…”

Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence

“…Georg Apfaltrer MD 1,2 ; Francesco Lavra MD 1,3 ; Carlo N. De Cecco MD, PhD 1 ; Akos Varga-Szemes MD, PhD 1 ; Marly van Assen BS 1,4 ; Domenico Mastrodicasa MD 1,4,5 ; Marco Scarabello MD 1,6 ; Marwen H. Eid MD 1 ; L. Parkwood Griffith MD 1 ; John W. Nance MD 1 ; Sheldon E. Litwin MD 1,7 ; Luca Saba MD 3 ; U. Joseph Schoepf MD 1,7…”

“…Ischemic stroke is a leading cause of mortality and long-term disability worldwide. Its recurrence is considered to be the major cause of its associated mortality and morbidity [1,2]. Cardiogenic strokes represent 20-30% of all ischemic cases and include various cardiac causes such as atrial fibrillation, acute myocardial infarction, or valvular heart diseases.…”

Cardiac CT Imaging for Ischemic Stroke: Current and Evolving Clinical Applications

“…In patients with prior stroke, the presence of large aortic plaques or complex aortic plaques at TEE has been shown to predict recurrent stroke events (75,76). By using an alternate method for diagnosing aortic plaque and stroke than those of TEE studies, a previous study demonstrated that aortic plaque detected by means of CT is associated with increased risk of early stroke recurrence after acute ischemic stroke (77). This supports the role of CT in diagnosing aortic plaque and assessing its contribution to recurrence.…”