To the Editor:
In the American Heart Association’s Scientific Statement on the Primary Prevention of Ischemic Stroke,1 the committee did not mention an important predisposing cause of stroke, namely aortic arch atherosclerosis, except to say that it is a cause of stroke during heart surgery. This pathological condition is an independent risk factor for stroke,2 with a prevalence on the same order of magnitude as that of carotid stenosis and atrial fibrillation in consecutive series of patients with spontaneous strokes.2,3 This important risk factor for stroke should be added to the otherwise comprehensive list presented by the Committee.
Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation. 2001; 103: 163–182.
Jones EF, Kalman JM, Calafiore P, et al. Proximal aortic atheroma: an independent risk factor for cerebral ischemia. Stroke. 1995; 26: 218–224.