Background & Purpose: In cryptogenic stroke or transient ischemic attack (TIA) patients, aortic arch atheroma or patent foramen ovale (PFO) evaluated by using transesophageal echocardiography (TEE) is well known as possible embolic source. These findings were sometimes associated with stroke recurrence. We investigated predictive factors for stroke recurrence in patients with cryptogenic stroke.
Methods: From February 2008 to December 2013, among 1832 consecutive stroke or TIA patients, 315 patients (male, 57.8%; age, 73.3±10.9) who were admitted within 7 days after the symptom onset without both atrial fibrillation and significant stenosis (50% or more in diameter) in the cerebral arteries underwent TEE for evaluating embolic sources; embolism was the probable etiological mechanism for their event. Patients with malignancy, cerebral arterial dissection, or infarcts in the perforating artery territory were excluded. We observed stroke recurrence during one year and investigated predictive factors for stroke recurrence.
Results: In TEE, spontaneous echo contrast in the left atrium, aortic arch atheroma of 4.0 mm or more in thickness (mean, 4.65±2.06 mm), PFO, and pulmonary arteriovenous fistula were observed in 24 (7.6%), 223 (70.3%), 26 (8.2%), and 20 (6.3%) patients, respectively. Stroke recurrence was observed in 39 (12.4%) patients. Aortic arch atheroma of 4.0 mm or more, male, and prior hemorrhagic stroke were more frequent, and the initial diastolic blood pressure (DBP) and HbA1c were higher in patients with than without stroke recurrence. On the multivariate analysis using those factors and age, aortic arch atheroma (OR 3.73, 95%CI 1.46–11.7) and the initial DBP (OR 1.03, 95%CI 1.00–1.05) were positive predictors for a stroke recurrence. With regard to the operating characteristic curve analysis, the most accurate cut off values for a stroke recurrence were 4.1mm (AUC 0.59) in aortic arch atheroma thickness and 91mmHg in DBP (AUC 0.58).
Conclusions: In acute cryptogenic stroke, aortic arch atheroma was observed frequently. Aortic arch atheroma and DBP were significantly associated with one-year stroke recurrence. TEE was required for evaluating aortic arch atheroma in patients with cryptogenic stroke