Ischemic lesion burden and characteristics of aortic atheroma

Background: To investigate whether ischemic lesion burden including lesion pattern, number, and volume would vary depending on risk stratification of aortic atheroma (AA). Methods: Acute stroke patients were enrolled if they had (1) acute ischemic lesions on diffusion-weighted imaging within 5 days of symptom onset, (2) cardioembolic stroke established through extensive workup, and (3) only ascending or arch AA detected by transesophageal echocardiography as an embolic source. AA was classified as complex (protruding ≥4 mm into the aortic lumen or any mobile or ulcerative component) or simple (<4 mm). Results: Eighty-one patients (male: 65.4% and age: 66.7 ± 11.0 years) were included in the study. Thirty-four patients (41.9%) had complex atheroma. These patients had a greater number of ischemic lesions (median: 2 lesions [range: 1-42] versus one lesion [range: 1-27], P =.017) and a larger infarct size (9.01 cc [range: 3.58-49.14] versus 4.6 cc [range: 2.3-13.28), P =.056) than the simple atheroma group. Multivariable logistic regression analysis showed that ischemic lesion volume was independently associated with complex atheroma (odds ratio: 1.03, 95% confidence interval: 1.002-2.148, P =.035), while multiple lesions were related (odds ratio: 3.03, 95% confidence interval:.88-10.42, P =.079). Conclusions: Ischemic lesion burden in patients with AA differed according to AA characteristics, suggesting that the morphological features of AA could reflect an embolic potential of AA.