[Role of complex aortic atheroma plaques in the recurrence of unexplained cerebral infarction]. / Papel de las placas complejas de ateroma aórtico en la recurrencia del infarto cerebral de etiología incierta.

INTRODUCTION AND OBJECTIVES: In a subgroup of patients with cerebral infarction, noninvasive diagnostic explorations fail to disclose the etiology. We studied the clinical course and the usefulness of transesophageal echocardiography to diagnose complex aortic atheroma plaques in patients with cerebral infarction of uncertain cause with recurrence of ischemia. PATIENTS AND METHOD: In a study population of 1840 consecutive patients with a first cerebral infarction evaluated with a screening protocol for transesophageal echocardiography, the etiology remained uncertain in 248 cases. These patients were followed during 1 year of treatment with antiplatelet agents, and transesophageal echocardiography was done if cerebral ischemia recurred. We compared the prevalence of complex aortic atheroma plaques in patients with recurrence and in patients with cerebral infarction of unknown etiology in the French Study of Aortic Plaques in Stroke, in whom there was no recurrence of cerebral infarction. RESULTS: Recurrent cerebral infarction was documented in 17 of our 248 patients with infarction of unknown etiology (6.9%). Transesophageal echocardiography established the etiology in 15 of these patients (88.2%) with complex aortic atheroma plaques being identified in 14 cases (82.4%). In contrast, in patients with cerebral infarction of unknown etiology in the French study without recurrent cerebral infarction during the first year of follow-up, the prevalence of complex plaques was 21.1% (P<.0001). CONCLUSIONS: During the first year of treatment with antiplatelet agents, most patients with cerebral infarction of unknown etiology had no recurrences. In the small subgroup with short-term recurrence, transesophageal echocardiography yielded the etiologic diagnosis in 88.2% of cases: the pathology most frequently involved was complex atherosclerotic disease of the aortic arch.

Papel de las placas complejas de ateroma aórtico en la recurrencia del infarto cerebral de etiología incierta / Role of complex aortic atheroma plaques in the recurrence of unexplained cerebral infarction

Introducción y objetivos. En un subgrupo de pacientes con infarto cerebral, las exploraciones diagnósticas no invasivas no permiten establecer un diagnóstico etiológico. Hemos estudiado su evolución y el valor del ecocardiograma transesofágico en el diagnóstico del ateroma complejo aórtico en pacientes con infarto cerebral de etiología incierta que presentan recurrencia. Pacientes y método. Al evaluar a 1.840 pacientes consecutivos con un primer infarto cerebral mediante un protocolo restrictivo para la ecocardiografía transesofágica, en 248 no pudo establecerse un diagnóstico etiológico. Durante 1 año de seguimiento con fármacos antiplaquetarios, se practicó un ecocardiograma transesofágico en caso de nuevo episodio isquémico cerebral. Se comparó la prevalencia de placas complejas aórticas en estos pacientes con recurrencia respecto a la de los infartos cerebrales de etiología incierta del French Study of Aortic Plaques in Stroke que no presentaron un segundo infarto cerebral. Resultados. Presentaron un segundo infarto cerebral 17 de los 248 pacientes con etiología incierta (6,9%). El ecocardiograma transesofágico estableció la etiología en 15 de ellos (88,2%), que fue atribuida a placas complejas de ateroma aórtico en 14 casos (82,4%). En cambio, entre los pacientes del French Study con infarto cerebral de etiología incierta que no presentaron reinfarto cerebral durante el primer año de seguimiento, la prevalencia de placas complejas aórticas fue del 21,1% (p < 0,0001). Conclusiones. Durante el primer año de seguimiento con antiagregantes, la mayoría de los pacientes con infarto cerebral de etiología incierta no presenta recurrencia. En el subgrupo con recurrencia isquémica cerebral, el ecocardiograma transesofágico permite establecer el diagnóstico definitivo en el 88,2% de los casos; la principal etiología implicada es la ateromatosis avanzada de la aorta torácica

Introduction and objectives. In a subgroup of patients with cerebral infarction, noninvasive diagnostic explorations fail to disclose the etiology. We studied the clinical course and the usefulness of transesophageal echocardiography to diagnose complex aortic atheroma plaques in patients with cerebral infarction of uncertain cause with recurrence of ischemia. Patients and method. In a study population of 1840 consecutive patients with a first cerebral infarction evaluated with a screening protocol for transesophageal echocardiography, the etiology remained uncertain in 248 cases. These patients were followed during 1 year of treatment with antiplatelet agents, and transesophageal echocardiography was done if cerebral ischemia recurred. We compared the prevalence of complex aortic atheroma plaques in patients with recurrence and in patients with cerebral infarction of unknown etiology in the French Study of Aortic Plaques in Stroke, in whom there was no recurrence of cerebral infarction. Results. Recurrent cerebral infarction was documented in 17 of our 248 patients with infarction of unknown etiology (6.9%). Transesophageal echocardiography established the etiology in 15 of these patients (88.2%) with complex aortic atheroma plaques being identified in 14 cases (82.4%). In contrast, in patients with cerebral infarction of unknown etiology in the French study without recurrent cerebral infarction during the first year of follow-up, the prevalence of complex plaques was 21.1% (P<.0001). Conclusions. During the first year of treatment with antiplatelet agents, most patients with cerebral infarction of unknown etiology had no recurrences. In the small subgroup with short-term recurrence, transesophageal echocardiography yielded the etiologic diagnosis in 88.2% of cases: the pathology most frequently involved was complex atherosclerotic disease of the aortic arch