Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients

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Stroke. 1994;25:2010-2016

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Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients

VG Davila-Roman, B Barzilai, TH Wareing, SF Murphy, KB Schechtman and NT Kouchoukos
Cardiovascular Division, Washington University, St Louis, MO 63110.

BACKGROUND AND PURPOSE: The cause of cerebral and peripheral embolism remains undetermined in a significant number of patients. An atherosclerotic thoracic aorta has thus far been considered to be an uncommon one. METHODS: To define the potential role of the ascending thoracic aorta as an embolic source, intraoperative ultrasonic aortic imaging was performed in 1200 of 1334 consecutive patients aged 50 years and older who were undergoing cardiac surgery. Patients were divided into two groups according to the results of the ultrasound study in terms of presence or absence of atherosclerotic disease. The prevalence of previous neurological events in the two groups was characterized and compared. RESULTS: Ascending aortic atherosclerosis was present in 231 (19.3%) of the patients studied. Patients in this category were older (P < .0001). A higher percentage of them were smokers (P < .0001) compared with patients with less severe disease. Coronary artery disease was more extensive (P = .012), and a higher percentage of these patients had a history of peripheral vascular disease (P < .0001). Univariate analysis of the subjects with (n = 158) and without (n = 1042) previous neurological events indicated that age, body mass index, atrial fibrillation, hypertension, and atherosclerosis of the ascending aorta were associated significantly with previous occurrence of a cerebrovascular accident. For the group as a whole, multiple logistic regression analysis demonstrated that hypertension (odds ratio, 1.81; P = .002), atherosclerosis of the ascending aorta (odds ratio, 1.65; P = .013), and atrial fibrillation (odds ratio, 1.54; P = .060) were significantly and independently associated with the occurrence of previous neurological events. CONCLUSIONS: Atherosclerosis of the ascending aorta is an independent risk factor for cerebrovascular events. An atherosclerotic ascending aorta may represent a potential source of emboli or may be a marker of generalized atherosclerosis.

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				A. Khosravi, C. A Skrabal, B. Westphal, G. Kundt, B. Greim, E. Kunesch, A. Liebold, and G. Steinhoff Evaluation of coated oxygenators in cardiopulmonary bypass systems and their impact on neurocognitive function Perfusion, September 1, 2005; 20(5): 249 - 254. [Abstract] [PDF]

				T. Schachner, A. Zimmer, G. Nagele, G. Laufer, and J. Bonatti Risk factors for late stroke after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 485 - 490. [Abstract] [Full Text] [PDF]

				J. M. Murkin Applied Neuromonitoring and Improving CNS Outcomes Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 139 - 142. [Abstract] [PDF]

				F. Farhat, L. Chalabreysse, C. Diab, S. Aubert, and O. Jegaden Histological aspects of the saphenous vein damage with the use of the symmetry(R) aortic connector system Interactive CardioVascular and Thoracic Surgery, June 1, 2004; 3(2): 373 - 375. [Abstract] [Full Text] [PDF]

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				P. Bergman, L. Hadjinikolaou, and J. van der Linden Aortic atheroma is related to number of particulates captured by intra-aortic filtration in CABG Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 539 - 544. [Abstract] [Full Text] [PDF]

				M. Swaminathan, B. J. McCreath, B. G. Phillips-Bute, M. F. Newman, J. P. Mathew, P. K. Smith, J. A. Blumenthal, and M. Stafford-Smith Serum Creatinine Patterns in Coronary Bypass Surgery Patients With and Without Postoperative Cognitive Dysfunction Anesth. Analg., July 1, 2002; 95(1): 1 - 8. [Abstract] [Full Text] [PDF]

				E. Schwammenthal, Y. Schwammenthal, D. Tanne, A. Tenenbaum, A. Garniek, M. Motro, B. Rabinowitz, M. Eldar, and M. S. Feinberg Transcutaneous detection of aortic arch atheromas by suprasternal harmonic imaging J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1127 - 1132. [Abstract] [Full Text] [PDF]

				G. S. Aldea, L. O. Soltow, W. L. Chandler, C. M. Triggs, C. R. Vocelka, G. I. Crockett, Y. T. Shin, W. E. Curtis, and E. D. Verrier Limitation of thrombin generation, platelet activation, and inflammation by elimination of cardiotomy suction in patients undergoing coronary artery bypass grafting treated with heparin-bonded circuits J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 742 - 755. [Abstract] [Full Text] [PDF]

				N. Moazami, N. G. Smedira, P. M. McCarthy, I. Katzan, C. A. Sila, B. W. Lytle, and D. M. Cosgrove III Safety and efficacy of intraarterial thrombolysis for perioperative stroke after cardiac operation Ann. Thorac. Surg., December 1, 2001; 72(6): 1933 - 1938. [Abstract] [Full Text] [PDF]

				M. G. Licina, R. M. Savage, C. Hearn, and E. J. Kraenzler The Role of Transesophageal Echocardiography in Perfusion Management Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 321 - 334. [Abstract] [PDF]

				J. M. Murkin Attenuation of neurologic injury during cardiac surgery Ann. Thorac. Surg., November 1, 2001; 72(5): S1838 - 1844. [Abstract] [Full Text] [PDF]

				J. van der Linden, L. Hadjinikolaou, P. Bergman, and D. Lindblom Postoperative stroke in cardiac surgery is related to the location and extent of atherosclerotic disease in the ascending aorta J. Am. Coll. Cardiol., July 1, 2001; 38(1): 131 - 135. [Abstract] [Full Text] [PDF]