대동맥 죽상경화를 동반한 급성 뇌경색 환자의 임상적 특징

Abstract

Background: Transesophageal echocardiography (TEE) is a useful tool for evaluating aortic plaques. Several investigators have reported that the aortic arch atherosclerosis is a potential source of systemic emboli and an independent risk factor for ischemic stroke. But the clinical characteristics and neuroimaging findings of the stroke patients with aortic plaques remain unknown. Methods: From Yonsei Stroke Registry, we reviewed 333 consecutive patients with acute ischemic stroke, who underwent both TEE and vascular imaging studies. We analyzed the risk factor profiles, clinical features, neuroimaging findings, and TEE data of these patients. Based on the TEE findings, the plaques protruding into the lumen≥4 mm, mobile or ulcerated lesions in the proximal aorta were defined as complex aortic plaques (CAP). The possible etiologies of stroke were classified into four groups; CAP only group, potential cardiac sources of embolism (PCSE) only group, relevant artery atherosclerosis (RAA) only group, and more than two etiologies or cryptogenic group (uncertain group). Results: Among the 333patients, aortic plaques were found in 105 (31.5%) patients, Fifty nine patients (17.7%) had the CAP. The patients with CAP were older (p<0.01) and had more frequent history of cigarette smoking (p=0.01) and ischemic stroke (p=0.04) than those without. Total cholesterol level was also higher (p=0.02). The etiologic evaluations revealed CAP only in 31 (9.3%), PCSE only in 68 (20.4%), RAA only in 59 (17.7%), uncertain mechanism in 175 (52.6%) patients. The CAP only group less often had cortical dysfunctions (9.7%, p<0.05), but more likely to have a classic lacunar syndrome (54.8%, <0.01). Less than 1 cm sized lesions were frequently found in CAP only group (55.6%), when compared with PCSE only (19.4%, p<0.01), RAA only (29.8%, p=0.03), or uncertain group (25.0%, p<0.01). Conclusions: Aortic plaques were frequently found in acute stroke patients. The CAPs were closely related with old age, smoking, previous stroke, and hypercholesterolemia. The clinical presentations of CAP patients were characterized by minor stroke symptoms and small lesion sizes.