Association between aortic atheroma and cerebral small vessel disease in patients with ischemic stroke

Tae Jin Song, Young Dae Kim, Joonsang Yoo, Jinkwon Kim, Hyuk Jae Chang, Geu Ru Hong, Chi Young Shim, Dongbeom Song, Ji Hoe Heo, Hyo Suk Nam

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background and Purpose Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. Methods We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. Results AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.441.85) and SAP (OR 1.54, 95% CI 1.35-1.75). Conclusions In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.

Original languageEnglish
Pages (from-to)312-320
Number of pages9
JournalJournal of Stroke
Volume18
Issue number3
DOIs
Publication statusPublished - 2016 Sep

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Cerebral Small Vessel Diseases
Atherosclerotic Plaques
Stroke
Odds Ratio
Lacunar Stroke
Transesophageal Echocardiography
Atherosclerosis
Confidence Intervals
Arteries
Magnetic Resonance Imaging
Brain

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Song, Tae Jin ; Kim, Young Dae ; Yoo, Joonsang ; Kim, Jinkwon ; Chang, Hyuk Jae ; Hong, Geu Ru ; Shim, Chi Young ; Song, Dongbeom ; Heo, Ji Hoe ; Nam, Hyo Suk. / Association between aortic atheroma and cerebral small vessel disease in patients with ischemic stroke. In: Journal of Stroke. 2016 ; Vol. 18, No. 3. pp. 312-320.
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title = "Association between aortic atheroma and cerebral small vessel disease in patients with ischemic stroke",
abstract = "Background and Purpose Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. Methods We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. Results AA was found by TEE in 360 (48.8{\%}) patients including 11.6{\%} with CAP and 37.2{\%} with SAP. One or more types of SVDs was found in 269 (36.4{\%}) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95{\%} confidence interval (CI) 1.441.85) and SAP (OR 1.54, 95{\%} CI 1.35-1.75). Conclusions In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.",
author = "Song, {Tae Jin} and Kim, {Young Dae} and Joonsang Yoo and Jinkwon Kim and Chang, {Hyuk Jae} and Hong, {Geu Ru} and Shim, {Chi Young} and Dongbeom Song and Heo, {Ji Hoe} and Nam, {Hyo Suk}",
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Association between aortic atheroma and cerebral small vessel disease in patients with ischemic stroke. / Song, Tae Jin; Kim, Young Dae; Yoo, Joonsang; Kim, Jinkwon; Chang, Hyuk Jae; Hong, Geu Ru; Shim, Chi Young; Song, Dongbeom; Heo, Ji Hoe; Nam, Hyo Suk.

In: Journal of Stroke, Vol. 18, No. 3, 09.2016, p. 312-320.

Research output: Contribution to journalArticle

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T1 - Association between aortic atheroma and cerebral small vessel disease in patients with ischemic stroke

AU - Song, Tae Jin

AU - Kim, Young Dae

AU - Yoo, Joonsang

AU - Kim, Jinkwon

AU - Chang, Hyuk Jae

AU - Hong, Geu Ru

AU - Shim, Chi Young

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AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

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N2 - Background and Purpose Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. Methods We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. Results AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.441.85) and SAP (OR 1.54, 95% CI 1.35-1.75). Conclusions In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.

AB - Background and Purpose Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. Methods We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. Results AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.441.85) and SAP (OR 1.54, 95% CI 1.35-1.75). Conclusions In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.

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