Predictors of aortic complicated lesions in stroke patients

Abstract

Aortic complicated lesions (ACLs) should be associated with cerebral infarction. Our aim was to develop a simple clinical scale (ACL scale) to predict the presence of ACL. Consecutive stroke patients undergoing transesophageal echocardiogram (TEE) examination were prospectively enrolled. We defined ACL as the presence of >4mm wall thickness, ulceration or mobile plaque in aortic arch. We also examined carotid intima-media thickness (IMT), ankle-brachial index (ABI) and brachial-ankle pulse-wave velocity (baPWV). We compared the clinical characteristics of patients with ACL (ACL group) and without ACL (non-ACL group), and devised a new ACL scale to predict the presence of ACL. In all, 165 patients (male 108, age 66.9 years) were enrolled and of these, 38% had ACL. The patients of the ACL group were older than those of the non-ACL group (73.0±10.2 vs. 63.1±13.6 years, P=0.001). Peripheral artery disease (PAD) was more frequent in the ACL group (18 vs. 4%, P=0.004). IMT was thicker in ACL group than in the non-ACL group (1.29±0.74 vs. 1.11±0.79mm, P=0.002), and baPWV was higher in the ACL group (2164.2±643.2 vs. 1833.7±492.9 cm s-1, P=0.001). We used three variables for determining the ACL scale score; (1) age >70, (2) presence of PAD and (3) smoking. The frequencies of ACL associated with ACL scale scores were as follows: 6% of patients with ACL scale score 0, 40% with score 1, 58% with score 2 and 100% with score 3. The ACL scale can predict the presence of aortic complicated lesions.