The Role of Aortic Arch Plaques in Cryptogenic Ischemic Stroke, Detected Using Computed Tomography Angiography

Background: Various studies have shown that aortic arch plaques play a role in recurrent vascular events.In this study, we aimed to demonstrate the role of aortic arch plaques detected by Computed Tomography Angiography (CTA) in the etiology of patients followed up due to CIS. Methods:In our retrospectively designed study, the data of 1819 ischemic stroke patients who were treated as inpatients over a two-year period were reviewed.Patients were diagnosed with CIS and CES according to the TOAST classification were included in the study.Plaques in the aortic arch were evaluated on a 3-point scale [grade 0= not present; grade 1= mild; grade 2= severe].Detected atherosclerotic plaques were classified as non-calcified (grade 1a or 2a) or calcified (grade 1b or 2b) on a segmental basis.Additionally, plaques were divided into 4 groups according to their CT morphology: (1) Hyperdense plaques, (2) hypodense plaques, (3) a combination of both plaques, (4) ulcerated/high-risk plaques >4mm.Results: A total of 244 patients whose data were fully available were included in the study.Among the patients,109 were female, and 135 were male, with a mean age of 69.0713.343.Of the patients,136 had CES, and 108 had CIS.Plaques in the aortic arch were detected in 105 of the CES patients and 64 of the CIS patients.The presence of plaques was statistically significant in CES patients (P=.003).The presence of plaques was also significantly higher in older patients (P<.001).When evaluated based on plaque morphology in CTA, a statistically significant difference was found between the groups (P=.010).In the grading performed based on plaque burden, Grade1b was observed most frequently.Grade2a was not observed in any group.When considering plaque burden, there was a statistically significant difference between the two groups (P=.001). Conclusion:Aortic arch atheroma is commonly seen in the general population.Further studies are needed to determine the role of these plaques in ischemic stroke and recurrent strokes,