Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation have a Risk for Aortogenic Embolizations

Abstract

We have a great interest in the article in Journal of Atherosclerosis and Thrombosis by Suzuki et al. titled Complex Aortic Arch Atherosclerosis in Acute Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation. The authors demonstrated that 38.7% transesophageal echocardiography-derived complex aortic arch plaques (CAPs) among 106 patients with acute ischemic strokes with atrial fibrillation (AF), suggesting that patients with acute ischemic stroke and AF often had CAPs. The atheromatous lesions at the aortic arch are one of the causes of ischemic strokes. The cause of acute ischemic strokes in patients with AF could not only be cardiogenic embolisms due to AF but also aortogenic embolisms due to CAPs. The possibility of concomitant CAPs should be considered for stroke patients with AF. Non-obstructive general angioscopy has the possibility to detect aortic plaques in the aortic arch more accurately than TEE and might help to diagnose atheromatous plaques and embolic materials in the aortic arch. Further studies are needed to elucidate the causes of ischemic strokes and are expected to improve the outcomes for acute ischemic strokes in patients with AF.

Keywords: Aortic atherosclerosis; Atrial fibrillation; Non-obstructive general angioscopy; Stroke.

Fig.1.

Diffusion-weighted magnetic resonance imaging shows high-intensity signals in the left striatum (A). Transesophageal echocardiography shows no thrombus in the left atrium and appendage (B) and indicates atherosclerotic plaques but no complex aortic arch plaque (C). Computed tomography angiography of the aortic arch (D). Non-obstructive general angioscopy detects atheromatous plaques (E–H).