(Stroke. 1999;30:2683.)
© 1999 American Heart Association, Inc.
Original Contributions |
Association Between Large Aortic Arch Atheromas and High-Intensity Transient Signals in Elderly Stroke Patients
Presented in part at the 24th American Heart Association International Conference on Stroke and Cerebral Circulation, Nashville, Tenn, February 4, 1999.
From the Neurological Institute (T.R., J.P.M., R.L.S.) and the Division of Cardiology (M.R.D.T., R.R.S., I.V.T., S.H.), New York Presbyterian Hospital, and the Division of Epidemiology and Gertrude H. Sergievsky Center (R.L.S.), School of Public Health, Columbia University, New York, NY.
Correspondence to Tanja Rundek, MD, Neurological Institute, Room 552, New York Presbyterian Hospital, 710 West 168th St, New York, NY 10032. E-mail tr89{at}columbia.edu
Background and Purpose—Aortic arch atheromas (AAs) have been shown to be a risk factor for ischemic stroke (IS) in the elderly because of their potential for cerebral embolization. However, the association between AAs and the presence of cerebral microemboli has not been clearly established. The aim of this study was to determine whether large AAs are associated with an increased frequency of high-intensity transient signals (HITS) in elderly patients with IS.
Methods—We performed bitemporal simultaneous HITS
monitoring of both middle cerebral arteries in 62 consecutive elderly
patients with acute IS (mean age 72.5±8.8 years, 65% men). In 16
patients, one or both temporal windows were inadequate; therefore, the
analysis of HITS was performed in the remaining 46 patients.
All patients underwent omniplane transesophageal
echocardiography (TEE), and they had no significant
extracranial or intracranial artery disease and no cardiac
prosthetic valves. Large AA was defined as 
4 mm in
thickness. Complex AA was defined as ulcerated or mobile, regardless of
plaque thickness. HITS monitoring was performed within 24 hours of TEE
and analyzed by an experienced neurologist-sonographer blinded
to TEE findings. A 9-dB threshold was chosen to discriminate HITS from
background Doppler signal. The HITS counts in the left and in the
right middle cerebral arteries were added and reported as a total
number of HITS in 30 minutes.
Results—HITS were detected in 14 (78%) of 18 patients with large AAs versus 8 (29%) of 28 patients with no or small AAs (odds ratio [OR] 8.8, 95% CI 2.2 to 34.8; P=0.001). The association was also present in 27 patients with no other cardiac embolic sources, such as atrial fibrillation, patent foramen ovale, spontaneous echo contrast, and thrombus (7 of 10 patients with large AAs versus 3 of 17 patients with small or no AA; OR 10.9, 95% CI 1.7 to 68.5; P=0.013). Complex AAs were associated with a higher frequency of HITS than were noncomplex AAs (6 of 6 patients with complex AAs versus 15 of 39 patients with noncomplex AAs; OR 2.6, 95% CI 1.7 to 3.9; P=0.005).
Conclusions—HITS are significantly associated with large AAs in elderly stroke patients. This observation may support the causal role of large AAs in IS.
Key Words: aortic arch • embolism • stroke, ischemic • ultrasonography, Doppler, transcranial
This article has been cited by other articles:
 |
|
 |
|
  C. Russo, Z. Jin, T. Rundek, S. Homma, R. L. Sacco, and M. R. Di Tullio Atherosclerotic Disease of the Proximal Aorta and the Risk of Vascular Events in a Population-Based Cohort: The Aortic Plaques and Risk of Ischemic Stroke (APRIS) Study Stroke, July 1, 2009; 40(7): 2313 - 2318. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Di Tullio, C. Russo, Z. Jin, R. L. Sacco, J.P. Mohr, S. Homma, and for the Patent Foramen Ovale in Cryptogenic Stroke Aortic Arch Plaques and Risk of Recurrent Stroke and Death Circulation, May 5, 2009; 119(17): 2376 - 2382. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Di Tullio, S. Homma, Z. Jin, and R. L. Sacco Aortic Atherosclerosis, Hypercoagulability, and Stroke: The APRIS (Aortic Plaque and Risk of Ischemic Stroke) Study J. Am. Coll. Cardiol., September 2, 2008; 52(10): 855 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Ueno, K. Kimura, Y. Iguchi, K. Shibazaki, T. Inoue, N. Hattori, and T. Urabe Mobile Aortic Plaques Are a Cause of Multiple Brain Infarcts Seen on Diffusion-Weighted Imaging Stroke, September 1, 2007; 38(9): 2470 - 2476. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L Rudolph, D. Tilahun, P. R Treanor, V. E Pochay, M. A Mahendrakar, P. Sagar, and V. L Babikian Use of a large bore syringe creates significantly fewer high intensity transient signals (HITS) into a cardiopulmonary bypass system than a small bore syringe Perfusion, January 1, 2006; 21(1): 67 - 71. [Abstract] [PDF]
|
|
|
|
|
|
K. Sugioka, T. Hozumi, R. R. Sciacca, Y. Miyake, I. Titova, G. Gaspard, R. L. Sacco, S. Homma, and M. R. Di Tullio Impact of Aortic Stiffness on Ischemic Stroke in Elderly Patients Stroke, August 1, 2002; 33(8): 2077 - 2081. [Abstract] [Full Text] [PDF]
|
|