Prevalence of Aortic Plaques in Cryptogenic Ischemic Stroke

Background and Purpose: Limited data is available regarding the prevalence of aortic plaques in cryptogenic ischemic strokes and its correlation with risk factors. Aim: To determine the prevalence of aortic plaques in patients with cryptogenic ischemic stroke and its association with vascular risk factors and future vascular events. Methodology: Patients with cryptogenic ischemic stroke/TIA evaluated with CT angiogram (CTA) were recruited. Aortic plaque thickness ≥4 mm, plaque ulceration, protruding components, and complex plaques were considered significant. Results: Of the 1,767 patients, 229 (12.9%) had cryptogenic ischemic stroke/transient ischemic attack (TIA). Of them, 36 (15.7%) patients were detected to have significant aortic plaques. The significant plaque group had a higher mean age (68.3 ± 8.3 vs 54.4 ± 13.2, P = 0.0005) and were more likely to have risk factors like hypertension (P = 0.025), coronary artery disease (CAD)(P = 0.015), and peripheral vascular disease (POVD) (P = 0.029). Plaque morphology showed plaques of ≥4 mm, ulcerated plaques, protruding components, and complex plaques in 14.8%, 5.6%, 3.1%, and 6.5% patients, respectively, which are predominantly located in the aortic arch (44%). At 1 year combined endpoint of stroke, TIA, and vascular death was significantly higher in the significant plaque group (19.4% vs 6.2%, P = 0.016). Advanced age (adjusted OR-1.11, 95% CI-1.07–1.17, P = <0.001) was identified as an independent risk factor for significant aortic plaques on multivariate analysis. Conclusions: Aortic plaques are an under-recognized cause of cryptogenic stroke. The significant risk factors in aortic plaque group highlight the importance of aggressive risk factor control for secondary stroke prevention.