Significance of aortic atheroma in elderly patients with ischemic stroke. A hospital-based study and literature review.

OBJECTIVES: Cardioembolism accounts for 15-30% of ischemic strokes. Transesophageal echocardiography (TEE) is useful in detecting potential sources of cardiac embolism. Aortic atheromas have recently been recognized as important causes of stroke. The aim of this study was to evaluate TEE findings in elderly patients with ischemic stroke. A review of literature was done to highlight the significance of aortic atherosclerotic disease in patients with ischemic stroke.

METHODS: One hundred consecutive patients with ischemic stroke aged > or =55 years underwent TEE for evaluation of cardiac sources of embolism. Patients with significant carotid artery stenosis (stenosis of >50% in common or internal carotid arteries) were excluded.

RESULTS: The most noteworthy finding was the high prevalence of complex atheromatous plaques in the ascending aorta and/or aortic arch (25%).

CONCLUSION: The present study demonstrates that TEE is helpful to detect cardiovascular sources of embolism in elderly patients with ischemic stroke. Aortic atheroma is present in 25% of elderly patients with ischemic stroke and without significant carotid artery stenosis. Aortic atherosclerosis may be an important cause of ischemic stroke in this population.