Complex atheromatous plaques in the descending aorta and the risk of stroke

A systematic review and meta-analysis

Aristeidis H. Katsanos, Sotirios Giannopoulos, Maria Kosmidou, Konstantinos Voumvourakis, John T. Parissis, Athanassios P. Kyritsis, Georgios Tsivgoulis

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background and Purpose: Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. METHODS-: We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. RESULTS-: We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. CONCLUSIONS-: Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism.

Original languageEnglish (US)
Pages (from-to)1764-1770
Number of pages7
JournalStroke
Volume45
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Atherosclerotic Plaques
Thoracic Aorta
Meta-Analysis
Stroke
Confidence Intervals
Cerebral Infarction
Atherosclerosis
Intracranial Embolism
Transesophageal Echocardiography
Embolism
Brain Ischemia
Observational Studies
Blood Vessels
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Katsanos, A. H., Giannopoulos, S., Kosmidou, M., Voumvourakis, K., Parissis, J. T., Kyritsis, A. P., & Tsivgoulis, G. (2014). Complex atheromatous plaques in the descending aorta and the risk of stroke: A systematic review and meta-analysis. Stroke, 45(6), 1764-1770. https://doi.org/10.1161/STROKEAHA.114.005190

Complex atheromatous plaques in the descending aorta and the risk of stroke : A systematic review and meta-analysis. / Katsanos, Aristeidis H.; Giannopoulos, Sotirios; Kosmidou, Maria; Voumvourakis, Konstantinos; Parissis, John T.; Kyritsis, Athanassios P.; Tsivgoulis, Georgios.

In: Stroke, Vol. 45, No. 6, 01.01.2014, p. 1764-1770.

Research output: Contribution to journalArticle

Katsanos, AH, Giannopoulos, S, Kosmidou, M, Voumvourakis, K, Parissis, JT, Kyritsis, AP & Tsivgoulis, G 2014, 'Complex atheromatous plaques in the descending aorta and the risk of stroke: A systematic review and meta-analysis', Stroke, vol. 45, no. 6, pp. 1764-1770. https://doi.org/10.1161/STROKEAHA.114.005190
Katsanos AH, Giannopoulos S, Kosmidou M, Voumvourakis K, Parissis JT, Kyritsis AP et al. Complex atheromatous plaques in the descending aorta and the risk of stroke: A systematic review and meta-analysis. Stroke. 2014 Jan 1;45(6):1764-1770. https://doi.org/10.1161/STROKEAHA.114.005190
Katsanos, Aristeidis H. ; Giannopoulos, Sotirios ; Kosmidou, Maria ; Voumvourakis, Konstantinos ; Parissis, John T. ; Kyritsis, Athanassios P. ; Tsivgoulis, Georgios. / Complex atheromatous plaques in the descending aorta and the risk of stroke : A systematic review and meta-analysis. In: Stroke. 2014 ; Vol. 45, No. 6. pp. 1764-1770.
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abstract = "Background and Purpose: Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. METHODS-: We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. RESULTS-: We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55{\%} men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4{\%}; 95{\%} confidence interval, 14.6-40.4{\%}) compared with unselected individuals (6.1{\%}; 95{\%} confidence interval, 3.4-10{\%}). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8{\%}; 95{\%} confidence interval, 17.5-26.9{\%}) and unclassified (28.3{\%}; 95{\%} confidence interval, 23.9-33.1{\%}) cerebral infarction. CONCLUSIONS-: Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism.",
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AU - Voumvourakis, Konstantinos

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