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(Circulation. 2007;116:928-935.)
© 2007 American Heart Association, Inc.

Stroke

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack

Souvik Sen, MD, MS; Alan Hinderliter, MD; Pranab K. Sen, PhD; Jennifer Simmons, BSW; James Beck, PhD; Steven Offenbacher, DDS, PhD, MMSc; E. Magnus Ohman, MD; Stephen M. Oppenheimer, MD, PhD

From the University of North Carolina Stroke Program, Departments of Neurology (S.S., J.S.), Cardiology (A.H., E.M.O.), Biostatistics (P.K.S.), Dental Ecology (J.B.), and Periodontology (S.O.), University of North Carolina, Chapel Hill, and Sentinent Medical Services (S.M.O.), Cockeysville, Md. Dr Ohman is now affiliated with Duke University Medical Center, Durham, NC.

Correspondence to Souvik Sen, MD, MS, FAHA, Director of UNC Hospital Stroke Center, Associate Professor of Neurology, 7003A Neuroscience Hospital, CB# 7025, Chapel Hill, NC 27599-7025. E-mail SenS{at}neurology.unc.edu

Received October 21, 2006; accepted June 15, 2007.

Background— It is not known whether progression of aortic arch (AA) atheroma is associated with vascular events in patients with stroke or transient ischemic attack (TIA).

Methods and Results— AA atheroma was detected on baseline transesophageal echocardiogram in 167 consecutive patients who had prevalent stroke or TIA. Of these, 125 consented to a follow-up transesophageal echocardiogram at 12 months. Adequate paired AA images were obtained in 117 (78 with strokes, 39 with TIAs), which allowed detailed measurements of plaques. On admission for their index stroke or TIA, patients were assessed for stroke risk factors, stroke subtypes, baseline AA plaque characteristics, and laboratory parameters. Progression of AA atheroma was observed in 33 patients (28%) on 12-month follow-up transesophageal echocardiogram. It was determined that the progression group had significantly higher adjusted homocysteine levels (P<0.0001) and neutrophil counts (P<0.0001) than the no-progression group. These patients were followed up for a median of 1.7 years from the index stroke/TIA (range 0.5 to 4.5 years) for vascular events including stroke, TIA, myocardial infarction, and death due to vascular causes. Kaplan-Meier curves showed fewer patients with AA atheroma progression remained free of the composite vascular end point (49% compared with 89% in the no-progression group; P<0.0001). AA atheroma progression was associated with composite vascular events (hazard ratio 5.8, 95% confidence interval 2.3 to 14.5, P=0.0002) after adjustment for a propensity score based on confounders.

Conclusions— In this preliminary study of stroke/TIA patients with AA atheroma on transesophageal echocardiogram, AA atheroma progression was associated with recurrent vascular events.

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