Aortic Arch Atherosclerosis in Patients With Embolic Stroke of Undetermined Source

• DOI: 10.1161/strokeaha.119.025813
• Publication Date: 2019-09-17T09:00:24Z
• Authors: George Ntaios; Lesly A. Pearce; Elena Meseguer; Matthias Endres; Pierre Amarenco; Serefnur Ozturk; Wilfried Lang; Natan M. Bornstein; Carlos A. Molina; Jorge Pagola; Hardi Mundl; Scott D. Berkowitz; Yan Yun Liu; Souvik Sen; Stuart J. Connolly; Robert G. Hart
• Keywords: Stroke

Background and Purpose- Aortic arch atherosclerosis (AAA) is a possible source of embolism in patients with embolic stroke undetermined source. Previous studies reported high rates events AAA, especially those high-risk AAA. This exploratory analysis NAVIGATE ESUS (New Approach Rivaroxaban Inhibition Factor Xa Global Trial Versus ASA to Prevent Embolism Embolic Stroke Undetermined Source) focused on AAA assessed their characteristics, recurrence rates, response treatment. Methods- The detection the assessment its features were based transesophageal echocardiography that was done 19% participants. plaques considered have complex when as or ulcerated ≥4 mm thickness had mobile thrombus present. Results- Among 1382 participants who echocardiography, 397 (29%) 112 (8%) Mean (SD) age (63 [10] versus 67 [9] 69 [9]; P<0.001), prevalence diabetes mellitus (19% 26%, 32%; P=0.002), aortic valvulopathy (10 20 20; P<0.001) increased across no noncomplex respectively. In multivariable analyses, increasing age, mellitus, valvulopathy, statin use before randomization, chronic infarcts imaging, region independently associated any also Multiterritorial qualifying rather than single-territory observed 21% 17% 13% (P=0.07). Annualized ischemic 7.2% 4.2% 5.6% for While risk score, after adjusting we did not observe recurrent (hazard ratio, 1.1; 95% CI, 0.53-2.4), although number outcomes limited. 4 strokes occurred among rivaroxaban-assigned aspirin-assigned patients. Conclusions- Complex prevalent atherosclerotic burden. Whether increases whether non-vitamin-K oral anticoagulant compared aspirin may be effective reducing requires additional study. Clinical Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02313909.