Analysis of Ischemic Stroke Patterns Using the Diffusion-Weighted Imaging in Patients with Complicated Aortic Plaques

J Korean Neurol Assoc > Volume 24(2); 2006 > Article

Journal of the Korean Neurological Association 2006;24(2): 106-111.

복합성 대동맥 죽상경화를 가진 환자들에서 확산강조영상을 이용한 뇌경색 유형 분석

하연수, 한상원 조광철 남효석a 김정연 백종삼 박재현

인제대학교 의과대학 상계백병원 신경과, 연세대학교 의과대학 신경과학교실a

Analysis of Ischemic Stroke Patterns Using the Diffusion-Weighted Imaging in Patients with Complicated Aortic Plaques

Yeon Soo Ha, M.D.,

Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul; Department of Neurology, Yonsei University College of Medicinea, Seoul, Korea

Abstract

Background: This study aimed at characterizing the lesion patterns in patients with acute ischemic stroke and complicated aortic plaques using the diffusion-weighted magnetic resonance imaging (DWI).
Methods: We retrospectively reviewed 403 consecutive patients with acute ischemic stroke between January 2002 and December 2004, and enrolled patients who had received a trans-esophageal echocardiography (TEE). All the patients should have an acute cerebral infarction within 7 days of the onset of symptoms. We analyzed the ischemic lesion patterns on DWI in the patients who had aortic atheroma protruded into the lumen greater than 4 mm in the aortic arch or ascending aorta (complicated aortic plaques; CAP). Ischemic lesions were classified into subcortical, cortical and multiple infarctions. We investigated the accompanying risk factors for atherosclerosis and stenosis of the relevant major brain artery as well.
Results: Of the 403 patients, TEE was performed in 210 (52%) and CAP was found in 25 (12%). Among 25 patients, subcortical infarction was observed in 15 (60%), followed by cortical infarction in 7 (28%), and multiple ischemic lesions in 3 (12%). CAP was frequently associated with hypertension and current smoking, and accompanied with stenosis of the relevant major brain artery as well (68%).
Conclusions: CAP may be a potential source of embolism. However, the high prevalence of the small subcortical lesion in this study questions the mechanisms of ischemic stroke in patients with aortic atheroma. CAP may be an uncomplicated marker of advanced systemic atherosclerosis including the cerebral arteries.KeyWords:Complicated aortic plaques, Ischemic stroke, Diffusion-weighted imaging