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From the Department of Neurology (J.W., S.A., F.D.), and the Division of
Cardiology, Department of Medicine (R.H., M.G.), The Mount Sinai School of
Medicine, New York, NY.
Correspondence to Jesse Weinberger, MD, Department of Neurology, Box 1052, The Mount Sinai School of Medicine, 1 Gustav Levy Place, New York, NY 10029. E-mail JesseWeinberger{at}mstplink.mssm.edu
Background and Purpose—Aortic arch
atherosclerotic plaque is a probable source of atheroembolic stroke.
Transesophageal echocardiography
(TEE) has been used to image the aorta of patients with stroke to
identify atherosclerotic plaque. TEE is moderately invasive and does
not always visualize plaques present in the distal ascending aorta
and proximal aortic arch.
Methods—In the current study, transcutaneous B-mode
ultrasonography was performed to image the aortic arch through a
lateral supraclavicular window, and the results were compared with
those of TEE in 20 patients. The aorta was subdivided into the proximal
ascending (PAsc), distal ascending (DAsc), proximal aortic arch (PAA),
and distal aortic arch (DAA) to be certain the plaques identified by
each technique were the same. Plaques were characterized as simple
(<4 mm thick) or complex (>4 mm thick).
Results—In the PAsc, 8 simple plaques were identified with TEE
but not with B-mode. In the DAsc, 1 complex plaque was identified with
both techniques, and B-mode identified 1 additional complex and 1
simple plaque. In the PAA, 6 simple and 5 complex plaques were
identified by both techniques, and TEE identified 1 additional complex
plaque. In the DAA, TEE identified 2 simple and 2 complex plaques;
B-mode identified 3 complex plaques.
Conclusions—B-mode imaging compared favorably with TEE in
identification of plaques in the aortic arch and distal ascending
aorta, although it could not identify simple plaques in the proximal
ascending. B-mode could visualize plaques not seen by TEE in the distal
ascending aorta. B-mode ultrasonography is complementary to TEE in
performance of a comprehensive assessment of plaque in the
aortic arch and provides a noninvasive method for sequential studies of
plaques that can be visualized.
© 1998 American Heart Association, Inc.
Original Contributions
A New Noninvasive Technique for Imaging Atherosclerotic Plaque in the Aortic Arch of Stroke Patients by Transcutaneous Real-Time B-Mode Ultrasonography
An Initial Report
Key Words: aortic arch • atherosclerosis • echocardiography, transesophageal • ultrasonography
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