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(Circulation. 2006;114:63-75.)
© 2006 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Aortic Atherosclerotic Disease and Stroke

Itzhak Kronzon, MD; Paul A. Tunick, MD

From the Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, New York University School of Medicine, New York.

Correspondence to Paul A. Tunick, MD, NYU School of Medicine, 560 1st Ave, New York, NY 10016. E-mail paul.tunick@med.nyu.edu

Key Words: atherosclerosis • stroke • heart diseases

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In the 1940s, most strokes were attributed to cerebral vasospasm, a mechanism that is not given a great deal of credence today. It was not until the early 1950s that Harvard neurologist C. Miller Fisher¹ stressed the importance of carotid artery atherosclerosis as a major cause of cerebral infarction. Later that decade, the importance of atrial fibrillation as a cause of cerebral embolism began to be stressed,² and the presence of a left atrial thrombus was first seen on angiocardiography in 1965.³ Despite the established importance of these 2 causes of stroke, carotid disease and atrial fibrillation, nearly half of strokes were listed as "of undetermined cause" in a large stroke registry as recently as 1989.⁴ In this series, 40% of 1273 cerebral infarctions in the Stroke Databank of the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) were thought to be cryptogenic (from the Latin crypticus, meaning secret or mysterious). The clinical syndrome in those patients, as well as the angiographic and computed tomographic (CT) findings, could be reclassified as embolic; however, because no source of embolus could be identified, the authors kept these strokes in the undetermined cause category.

In 1990, a third leading cause of embolic stroke was identified on transesophageal echocardiography (TEE), namely severe atherosclerotic plaques in the aortic arch.⁵ The 3 patients described in that initial report were a 68-year-old woman with dysarthria and an embolus to the foot, a 77-year-old woman with a cerebellar infarction after cardiac catheterization, and a 70-year-old . . . [Full Text of this Article]

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