10.1177/1051228403259158 ARTICLE Journal of Neuroimaging Vol 14 No 1 January 2004 Yahia et al: Aortic Plaques in TIA and Stroke Clinical Investigative Studies Characteristics and Predictors of Aortic Plaques in Patients With Transient Ischemic Attacks and Strokes Abutaher M. Yahia, MD Jawad F. Kirmani, MD Andrew R. Xavier, MD Aasma Shaukat, MD, MPH Adnan I. Qureshi, MD ABSTRACT Objective. To identify the prevalence and characteristics of aor- tic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events. Background. Aortic atheroma is associated with ischemic stroke. Its characteristics, including morphology and distribution among different stroke subtypes, are not well described. Method.FromJuly2000toAugust2001,allpatients evaluated by transesophageal echocardiography (TEE) with diagnosesoftransientischemicattacks(TIAs)andstrokeswere prospectively studied. Demographics, including age, gender, ethnicity, cerebrovascular risk factors, and stroke subtypes, were collected. Results. Thoracic aortic atheromas (TAAs) were present in 141 of 237 patients (59%) (mean age = 59 ± 14, 119 [50%]male).Mildplaque(<2mm)waspresentin13of237(5%), moderate plaque (2-4 mm) in 49 (21%), severe plaque (≥4 mm) in 79 (33%), and complex plaque in 64 (27%). Patients’ ages (odds ratio [OR] = 1.05, confidence interval [CI] 1.03-1.08, P < .001),coronaryarterydisease(OR=2.2,CI1.02-4.8, P <.042), and patent foramen ovale (PFO) (OR = 0.39, CI 0.22-0.70, P < .002) were associated with the severity and complexity of aortic plaque.Inmultivariateanalysis,age(OR=1.06,CI1.03-1.08, P <.001)andthepresenceofPFO(OR=0.35,CI0.18-0.65, P < .001) continued to be significant to the severity and complexity ofaorticatheroma.Gender,historyofstroke,hypertension,dia- betes mellitus, hyperlipidemia, and history of smoking were not associated with TAA. Conclusion.OnethirdofTAAplaquesare severeandcomplexinnatureandmorefrequentlypresentinthe descending aorta and the arch of the aorta than in the ascend- ing aorta. TEE should be considered for the early detection and treatmentofTAAinpatientswithoutidentifiedcausesofstroke. Key words: Transesophageal echocardiography, thoracic aortic atheroma, severe plaque, complex plaque, mobile plaque, transient ischemic attack, stroke. Yahia AM, Kirmani JF, Xavier AR, Shaukat A, Qureshi AI. Characteristics and predictors of aortic plaques in patients with transient ischemic attacks and strokes. J Neuroimaging 2004;14:16-22. DOI: 10.1177/1051228403259158 With the advent of transesophageal echocardiography (TEE), thoracic aortic atheroma (TAA) has emerged as an important source of cerebral embolism. The prevalence of TAA is approximately 27% in patients with previous histories of thromboembolisms. 1 The risk for recurrent strokes with TAA is approximately 12% per year, and the combined risk for strokes and peripheral embolisms is 33%. 1 The mortality rate is also significantly higher in patients with severe TAA than in patients without TAA. 2 TAA is not only a risk factor for cortical strokes, it is also a potential source for lacunar strokes. 3 The risk for ischemic stroke in patients with complex aortic atheroma is approximately 22.4%, as opposed to 2.6% in control patients. The stroke and mortality risks in patients under- 16 Copyright © 2004 by the American Society of Neuroimaging Received June 9, 2003, and in revised form July 30, 2003. Accepted for publication August 2, 2003. From the Department of Neurology and Neurosciences (AMY, JFK, ARX, AIQ), University of Medicine and Dentistry of New Jersey, Newark; and the Department of Medicine (AS) and the Department of Neurosurgery and Toshiba Stroke Research Center (AIQ), State University of New York, Buffalo. Address correspondence to Abutaher M. Yahia, MD, Di- vision of Neurocardiology, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, 185 South Orange Avenue, MSB H-506, Newark, NJ 07103-2757. E-mail: yahia25@hotmail.com.