Stroke: ascending aortic arch atheroma was a risk factor for cerebral infarction.

Clinical bottom line (level 3b)

  1. About 1% of patients had a proximal aortic atheroma.
  2. Risk factors for cerebral infarction in patients with a first nonhaemorrhagic stroke or witnessed TIA were; simple or complex ascending aortic arch atheroma, atrial fibrillation, hypertension, smoking, diabetes mellitus, cardiac source of embolism or = 60% carotid stenosis.
Jones et al: Stroke 1995; 26: 218-224
Expires December 2003

The study

Case-control study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: stroke unit of a general hospital, Australia

427 patients (aged range 18 to 89 years; mean 65, 56% male) first nonhaemorrhagic stroke or witnessed transient ischaemic attack, or controls

Excluded if
  • inadequate visualisation of the aortic arch with monoplase oesophageal probe
  • too unwell or died early
  • <18 years old
  • inability to provide informed consent for study procedures
  • any contraindication to transoesophageal echocardiography


    • Cases: 215 patients (% male, mean age ): first nonhaemorrhagic stroke or transient ischaemic attacks
    Controls: 202 patients (% male, mean age ): controls with no history of stroke or TIA


    Multiple logistic regression was used to adjust for confounding factors.

    Outcomes studied:
  • cerebral ischaemia

    • All subjects underwent both transthoracic and transoesophageal echocardiography within one week of presenting ischaemic event for patients or electively for controls.

    The evidence

    Patient expected event rate for cerebral ischaemia: 1.00%
    risk factor for
    cerebral ischaemia     		adjusted OR
    (95% CI)    		 NNH
    (95% CI)
    = 60% carotid stenosis 16.9
    (2.00 to 144)     		7
    (2 to 102)
    ascending aortic or arch atheroma (complex) 7.10
    (2.70 to 18.4)     		18
    (7 to 60)
    atrial fibrillation 4.80
    (1.80 to 12.6)     		28
    (10 to 127)
    diabetes mellitus 4.10
    (1.40 to 12.2)     		34
    (10 to 254)
    smoking 2.60
    (1.10 to 6.30)     		64
    (20 to 1011)
    ascending aortic arch atheroma (simple) 2.30
    (1.20 to 4.20)     		79
    (33 to 506)
    cardiac source of embolism 2.10
    (1.20 to 3.70)     		93
    (38 to 506)
    hypertension 1.90
    (1.10 to 3.20)     		113
    (47 to 1011)

    Citation

    1. Jones EF, Kalman JM, Calafiore P, et al: Proximal aortic atheroma: an independent risk factor for cerebral ischaemia. Stroke 1995; 26: 218-224
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure proximal aortic atheroma
    Comparison no proximal aortic atheroma
    Outcome cerebral ischaemia