Aortic arch plaques and risk of recurrent stroke and death

Marco R. Di Tullio, Cesare Russo, Zhezhen Jin, Ralph L Sacco, J. P. Mohr, Shunichi Homma

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

BACKGROUND-: Aortic arch plaques are a risk factor for ischemic stroke. Although the stroke mechanism is conceivably thromboembolic, no randomized studies have evaluated the efficacy of antithrombotic therapies in preventing recurrent events. METHODS AND RESULTS-: The relationship between arch plaques and recurrent events was studied in 516 patients with ischemic stroke who were double-blindly randomized to treatment with warfarin or aspirin as part of the Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS), based on the Warfarin-Aspirin Recurrent Stroke Study (WARSS). Plaque thickness and morphology were evaluated by transesophageal echocardiography. End points were recurrent ischemic stroke or death over a 2-year follow-up. Large plaques (≥ 4 mm) were present in 19.6% of patients; large complex plaques (those with ulcerations or mobile components) were seen in 8.5%. During follow-up, large plaques were associated with a significantly increased risk of events (adjusted hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.04 to 4.32), especially those with complex morphology (HR, 2.55; 95 CI, 1.10 to 5.89). The risk was highest among cryptogenic stroke patients, both for large plaques (HR, 6.42; 95% CI, 1.62 to 25.46) and large complex plaques (HR, 9.50; 95% CI, 1.92 to 47.10). Event rates were similar in the warfarin and aspirin groups in the overall study population (16.4% versus 15.8%; P=0.43). CONCLUSIONS-: In patients with stroke, especially cryptogenic stroke, large aortic plaques remain associated with an increased risk of recurrent stroke and death at 2 years despite treatment with warfarin or aspirin. Complex plaque morphology confers a slight additional increase in risk.

Original languageEnglish
Pages (from-to)2376-2382
Number of pages7
JournalCirculation
Volume119
Issue number17
DOIs
StatePublished - May 5 2009

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Thoracic Aorta
Stroke
Warfarin
Aspirin
Confidence Intervals
Patent Foramen Ovale
Transesophageal Echocardiography
Therapeutics

Keywords

  • Aorta
  • Atherosclerosis
  • Echocardiography
  • Stroke

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Di Tullio, M. R., Russo, C., Jin, Z., Sacco, R. L., Mohr, J. P., & Homma, S. (2009). Aortic arch plaques and risk of recurrent stroke and death. Circulation, 119(17), 2376-2382. https://doi.org/10.1161/CIRCULATIONAHA.108.811935

Aortic arch plaques and risk of recurrent stroke and death. / Di Tullio, Marco R.; Russo, Cesare; Jin, Zhezhen; Sacco, Ralph L; Mohr, J. P.; Homma, Shunichi.

In: Circulation, Vol. 119, No. 17, 05.05.2009, p. 2376-2382.

Research output: Contribution to journalArticle

Di Tullio, MR, Russo, C, Jin, Z, Sacco, RL, Mohr, JP & Homma, S 2009, 'Aortic arch plaques and risk of recurrent stroke and death', Circulation, vol. 119, no. 17, pp. 2376-2382. https://doi.org/10.1161/CIRCULATIONAHA.108.811935
Di Tullio, Marco R. ; Russo, Cesare ; Jin, Zhezhen ; Sacco, Ralph L ; Mohr, J. P. ; Homma, Shunichi. / Aortic arch plaques and risk of recurrent stroke and death. In: Circulation. 2009 ; Vol. 119, No. 17. pp. 2376-2382.
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abstract = "BACKGROUND-: Aortic arch plaques are a risk factor for ischemic stroke. Although the stroke mechanism is conceivably thromboembolic, no randomized studies have evaluated the efficacy of antithrombotic therapies in preventing recurrent events. METHODS AND RESULTS-: The relationship between arch plaques and recurrent events was studied in 516 patients with ischemic stroke who were double-blindly randomized to treatment with warfarin or aspirin as part of the Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS), based on the Warfarin-Aspirin Recurrent Stroke Study (WARSS). Plaque thickness and morphology were evaluated by transesophageal echocardiography. End points were recurrent ischemic stroke or death over a 2-year follow-up. Large plaques (≥ 4 mm) were present in 19.6{\%} of patients; large complex plaques (those with ulcerations or mobile components) were seen in 8.5{\%}. During follow-up, large plaques were associated with a significantly increased risk of events (adjusted hazard ratio [HR], 2.12; 95{\%} confidence interval [CI], 1.04 to 4.32), especially those with complex morphology (HR, 2.55; 95 CI, 1.10 to 5.89). The risk was highest among cryptogenic stroke patients, both for large plaques (HR, 6.42; 95{\%} CI, 1.62 to 25.46) and large complex plaques (HR, 9.50; 95{\%} CI, 1.92 to 47.10). Event rates were similar in the warfarin and aspirin groups in the overall study population (16.4{\%} versus 15.8{\%}; P=0.43). CONCLUSIONS-: In patients with stroke, especially cryptogenic stroke, large aortic plaques remain associated with an increased risk of recurrent stroke and death at 2 years despite treatment with warfarin or aspirin. Complex plaque morphology confers a slight additional increase in risk.",
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AU - Di Tullio, Marco R.

AU - Russo, Cesare

AU - Jin, Zhezhen

AU - Sacco, Ralph L

AU - Mohr, J. P.

AU - Homma, Shunichi

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N2 - BACKGROUND-: Aortic arch plaques are a risk factor for ischemic stroke. Although the stroke mechanism is conceivably thromboembolic, no randomized studies have evaluated the efficacy of antithrombotic therapies in preventing recurrent events. METHODS AND RESULTS-: The relationship between arch plaques and recurrent events was studied in 516 patients with ischemic stroke who were double-blindly randomized to treatment with warfarin or aspirin as part of the Patent Foramen Ovale in Cryptogenic Stroke Study (PICSS), based on the Warfarin-Aspirin Recurrent Stroke Study (WARSS). Plaque thickness and morphology were evaluated by transesophageal echocardiography. End points were recurrent ischemic stroke or death over a 2-year follow-up. Large plaques (≥ 4 mm) were present in 19.6% of patients; large complex plaques (those with ulcerations or mobile components) were seen in 8.5%. During follow-up, large plaques were associated with a significantly increased risk of events (adjusted hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.04 to 4.32), especially those with complex morphology (HR, 2.55; 95 CI, 1.10 to 5.89). The risk was highest among cryptogenic stroke patients, both for large plaques (HR, 6.42; 95% CI, 1.62 to 25.46) and large complex plaques (HR, 9.50; 95% CI, 1.92 to 47.10). Event rates were similar in the warfarin and aspirin groups in the overall study population (16.4% versus 15.8%; P=0.43). CONCLUSIONS-: In patients with stroke, especially cryptogenic stroke, large aortic plaques remain associated with an increased risk of recurrent stroke and death at 2 years despite treatment with warfarin or aspirin. Complex plaque morphology confers a slight additional increase in risk.

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KW - Atherosclerosis

KW - Echocardiography

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