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Different infarction patterns in patients with aortic atheroma compared to those with cardioembolism or large artery atherosclerosis

 Seung Woo Kim  ;  Young Dae Kim  ;  Hyuk-Jae Chang  ;  Geu-Ru Hong  ;  Chi Young Shim  ;  Seok Jong Chung  ;  Jin Yong Hong  ;  Tae-Jin Song  ;  Dongbeom Song  ;  Oh Young Bang  ;  Ji Hoe Heo  ;  Hyo Suk Nam 
 Journal of Neurology, Vol.265(1) : 151-158, 2018 
Journal Title
 Journal of Neurology 
Issue Date
Aged ; Arteries/pathology ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/etiology* ; Cerebral Cortex/blood supply ; Cerebral Cortex/pathology ; Diffusion Magnetic Resonance Imaging ; Embolism/diagnostic imaging ; Embolism/pathology* ; Female ; Humans ; Infarction/diagnostic imaging ; Male ; Middle Aged ; Plaque, Atherosclerotic/diagnostic imaging ; Plaque, Atherosclerotic/pathology* ; Retrospective Studies ; Risk Factors ; Statistics, Nonparametric ; Stroke/complications* ; Stroke/diagnostic imaging
Aortic arch atheroma ; Diffusion-weighted imaging ; Ischemic stroke ; Transesophageal echocardiography
Aortic atheroma is a known cause of ischemic stroke. However, it is unclear whether ischemic stroke is caused by emboli from aortic atheroma or by accompanying atherosclerosis. In this study, we evaluated lesion patterns of patients with complex aortic plaque (CAP) to assume the underlying pathophysiology. Acute ischemic stroke patients who underwent transesophageal echocardiography were included. CAP was defined as a plaque in the proximal aorta ≥ 4 mm thick or with a mobile component. The diffusion-weighted imaging lesion patterns of patients with CAP were compared to those with large arterial atherosclerosis (LAA) or cardioembolism (CE). A total of 64 CAP patients, 127 LAA patients, and 80 CE patients were included. Small cortical pattern was more common in the CAP group (45.3%) than in the LAA (7.9%, p < 0.001) or the CE group (23.8%, p = 0.018). A large cortical pattern was more common in the CE group than in the CAP group (p < 0.001), whereas subcortical only pattern tended to be more common in the CAP group than in the CE group (p = 0.057). In multinominal analysis, the CAP group was more likely to have a small cortical lesion than the LAA group [odds ratio (OR) 14.63; 95% confidence interval (CI) 4.67-45.85] or the CE (OR 3.69, 95% CI 1.19-11.39) group. In conclusion, patients with CAP frequently had small cortical lesions or subcortical single lesion. These findings imply that ischemic stroke in aortic atheroma patients is associated with either small emboli or small artery disease.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김승우(Kim, Seung Woo) ORCID logo https://orcid.org/0000-0002-5621-0811
김영대(Kim, Young Dae) ORCID logo https://orcid.org/0000-0001-5750-2616
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정석종(Chung, Seok Jong) ORCID logo https://orcid.org/0000-0001-6086-3199
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
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