Atheroma stroke risk

Homocysteine—still under study, but hyperhomocysteinemia may be related to increased stroke risk Asymptomatic carotid stenosis Subclinical disease—aortic arch atheromas Multiple Risk Factors—Stroke Is Increased by the Presence of Multiple Risk Factors Framingham profile... 

Approximately 90% of atherothromboembolic strokes in whites are caused by atheroma in the extracranial vessels, whereas intracranial disease appears to be equally important in blacks and Hispanics (Sacco et al. 1995 Wityk et al. 1996). Atheromatous disease in the ascending aorta and the aortic arch is increasingly recognized as a source of cerebral emboli and an independent risk factor for ischemic stroke in vivo (Amarenco et al. 1994 Jones et al. 1995 Heinzlef et al. 1997 MacLeod et al. 2004). 

Part 2. Pathogenic mechanisms of clinical syndromes a literature investigation. Rheumatology (Oxford) 41 619-630 Jones EF, Kalman JM, Calafiore P et al. (1995). Proximal aortic atheroma. An independent risk factor for cerebral ischemia. Stroke 26 218-224... 

Innominate or proximal common carotid artery stenosis or occlusion is quite often seen on angiograms in symptomatic patients but, unless very severe, does not influence the decision about endarterectomy for any internal carotid artery stenosis. Although it is possible to bypass such lesions, it is highly doubtful whether this reduces the risk of stroke unless, perhaps, several major neck vessels are involved and the patient has low-flow cerebral or ocular symptoms. This very rare situation can be caused by atheroma, Takayasu s disease or aortic dissection. Clearly, close consultation between physicians and vascular surgeons is needed to sort out, on an individual patient basis, what to do for the best. 

Aortic arch atheroma is now increasingly diagnosed by transesophageal echocardiography in patients with TIAs or ischemic stroke, but so far there are no surgical, or indeed medical, treatment options over and above controlling vascular risk factors and antiplatelet drugs. One trial of medical treatment has been started, the Aortic Arch Related Cerebral Hazard (ARCH) trial (MacLeod et al. 2004). 

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