Aortic Sinotubular Atherosclerotic Debris Associated with Cerebral Embolic Events Can Be Identifiedby Transthoracic Echocardiography

OBJECTIVE: To evaluate the association between the presence of aortic sinotubular debris (STAD) identified by transthoracic echocardiography (TTE) and embolic strokes. BACKGROUND: The presence of atherosclerotic debris in the ascending aorta or aortic arch detected by transesophageal echocardiography or epiaortic echocardiography has been well established to be correlated with embolic stroke or other thromboembolic events. No data are available on the role of TTE in describing aortic pathology in thromboembolic events. METHODS: We identified 60 transthoracic echocardiographic studies from 11,275 studies, in which STAD was diagnosed. The charts of these patients (group 1; mean age 67 +/- 10 years) were reviewed and compared with those of 57 patients (group 2) without STAD, matched for age, gender and risk factors for advanced atherosclerosis. The results of brain imaging procedures, carotid duplex and coronary angiography were also reviewed. RESULTS: Ischemic stroke was found in 15 of group 1 (25%) and 4 patients of group 2 (7%, odds ratio = 4.4; 95% confidence interval, 1.3-19.4, p = 0.008). The average thickness of STAD was 0.7 +/- 0.2 cm in stroke patients and 0.6 +/- 0.2 cm in patients without stroke (p = n.s.). STAD was associated with </=40% carotid artery stenosis. CONCLUSION: STAD detected by TTE is strongly associated with embolic strokes. Our findings expand the role of TTE in the evaluation of patients with embolic strokes.