Turk J Cerebrovasc Dis. 2025; 31(2): 104-107 | DOI: 10.5505/tjcvd.2025.99267

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

Eylem Özaydýn Göksu¹, Aylin Aytekin², Þennur Delibaþ Katý¹, Ender Uysal^1
1Department of Neurology, Antalya Training and Research Hospital, Antalya, Türkiye
²Department of Neurology, Çankýrý State Hospital, Çankýrý, Türkiye

INTRODUCTION: 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 69.07±13.343. 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).
DISCUSSION AND 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,

Keywords: Cryptogenic ischemic stroke, aortic arch plaques, CT angiography

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Bilgisayarlý Tomografi Anjiografi Kullanýlarak Tespit Edilen Aortik Ark Plaklarýnýn Kriptojenik Iskemik Inmedeki Rolü

Eylem Özaydýn Göksu¹, Aylin Aytekin², Þennur Delibaþ Katý¹, Ender Uysal^1
1Antalya Eðitim Araþtýrma Hastanesi, Nöroloji Kliniði, Antalya, Türkiye
²Çankýrý Devlet Hastanesi, Nöroloji, Çankýrý, Türkiye

GÝRÝÞ ve AMAÇ: Çeþitli çalýþmalar aort ark plaklarýnýn tekrarlayan vasküler olaylarda rol oynadýðýný göstermiþtir. Bu çalýþmada, CIS nedeniyle takip edilen hastalarýn etiyolojisinde Bilgisayarlý Tomografi Anjiyografi (BTA) ile tespit edilen aort ark plaklarýnýn rolünü göstermeyi amaçladýk.
YÖNTEM ve GEREÇLER: Retrospektif olarak tasarlanan çalýþmamýzda, iki yýllýk süre boyunca yatarak tedavi gören 1819 iskemik inme hastasýnýn verileri incelendi. TOAST sýnýflamasýna göre CIS ve CES tanýsý alan hastalar çalýþmaya dahil edildi. Aort arkýndaki plaklar 3 puanlý bir skala ile deðerlendirildi [derece 0= yok; derece 1= hafif; derece 2= þiddetli]. Tespit edilen aterosklerotik plaklar segmental bazda kalsifiye olmayan (derece 1a veya 2a) veya kalsifiye (derece 1b veya 2b) olarak sýnýflandýrýldý. Ek olarak, plaklar BT morfolojilerine göre 4 gruba ayrýldý: (1) Hiperdens plaklar, (2) Hipodens plaklar, (3) Her iki plaðýn kombinasyonu, (4) Ülserasyonlu / yüksek riskli plaklar > 4 mm.
BULGULAR: Verileri tamamen mevcut olan toplam 244 hasta çalýþmaya dahil edildi. Hastalarýn 109'u kadýn, 135'i erkekti ve yaþ ortalamalarý 69,07±13,343 idi. Hastalarýn 136'sýnda CES, 108'inde CIS vardý. Aort arkýnda plaklar CES hastalarýnýn 105'inde ve CIS hastalarýnýn 64'ünde tespit edildi. CES hastalarýnda plak varlýðý istatistiksel olarak anlamlýydý (P=,003). Yaþlý hastalarda plak varlýðý da anlamlý olarak daha yüksekti (P<,001). BTA'da plak morfolojisine göre deðerlendirildiðinde gruplar arasýnda istatistiksel olarak anlamlý fark bulundu (P=,010). Plak yüküne göre yapýlan derecelendirmede en sýk Grade1b gözlendi. Grade2a hiçbir grupta gözlenmedi. Plak yükü dikkate alýndýðýnda iki grup arasýnda istatistiksel olarak anlamlý fark bulundu (P=,001).
TARTIÞMA ve SONUÇ: Aort arký ateromu genel popülasyonda yaygýn olarak görülmektedir. Bu plaklarýn iskemik inme ve tekrarlayan inmelerdeki rolünü belirlemek için daha fazla çalýþmaya ihtiyaç vardýr.

Anahtar Kelimeler: Kriptojenik iskemik inme, aortik ark plaklarý, BT anjiografi

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