The Relationship Between Aortic Arch Calcification and Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source—A Case-Control Study

Abstract

BackgroundAortic arch calcification (AoAC) is associated with plaque development and cardiovascular events. We aimed to estimate the predictive value of AoAC for stroke recurrence in patients with embolic stroke of undetermined source (ESUS).MethodsConsecutive patients with ESUS who were admitted to our center between October 2019 and October 2020 and who had a 1-year follow-up of stroke recurrence were retrospectively reviewed. According to our AoAC grading scale (AGS), AoAC was classified into four grades based on chest computed tomography (CT) findings: no visible calcification (grade 0), spotty calcification (grade 1), lamellar calcification (grade 2), and circular calcification (grade 3).ResultsOf the 158 patients with ESUS (age, 62.1 ± 14.5 years; 120 men) enrolled, 24 (15.2%) had recurrent stroke within a 1-year follow-up. The Cox regression analysis showed that stroke history [hazard ratio (HR), 4.625; 95% confidence interval (CI), 1.828–11.700, p = 0.001] and AoAC (HR, 2.672; 95% CI, 1.129–6.319; p = 0.025) predicted recurrent stroke. AGS grade 1 was associated with a significantly higher risk of stroke recurrence than AGS grade 0 (HR, 5.033; 95% CI, 1.858–13.635, p = 0.001) and AGS grade 2 plus 3 (HR, 3.388; 95% CI, 1.124–10.206, p = 0.030). In patients with AoAC, receiver operating characteristic (ROC) analysis showed that AGS had a good value in predicting stroke recurrence in patients with ESUS, with an area under curve (AUC) of 0.735 (95% CI = 0.601–0.869, p = 0.005).ConclusionsAortic arch calcification, especially spotty calcification, had a good predictive value for stroke recurrence in patients with ESUS.

Precranial artery calcification burden: a potential indicator of the clinical outcome of reperfusion in patients with acute large artery occlusion

“…According to the AGS, the AoAC on baseline chest CT was divided into no visible calcification (0 points), spotty calcification (1 point), lamellar calcification (2 points), and circular calcification (3 points) (Figure 1(a)). 10 According to the Woodcock visual score, CaSC on baseline non-contrast cranial CT was divided into no visible calcification (0 points), thin discontinuous calcification (1 point), thin continuous or thick discontinuous calcification (2 points), and thick continuous calcification (3 points) (Figure 1(b)). 11 According to our observational assumption, patients with PACB scores 3 to 6 were assigned to the severe calcification group, and those with PACB scores 0 to 2 were assigned to the non-severe calcification group.…”

“… 9 Because the aortic arch to the carotid artery is the only way for intravenous recombinant tissue plasminogen activator (rt-PA) or thrombectomy devices to enter the brain, we hypothesized that assessment of the calcification burden of AoAC and CaSC may be a factor in predicting the outcomes of reperfusion therapy. Two visual calcification grading systems, the AoAC grading scale 10 and CaSC Woodcock visual score, 11 have been used to accurately assess the degree of calcification on non-contrast computed tomography (NCCT). Therefore, we aimed to investigate the associations between pretreatment pre-cranial artery calcification burden (PACB; AoAC plus CaSC score) and outcomes for patients with LAO stroke who receive reperfusion treatment.…”