Aortic arch atheroma
Identifieur interne : 009A43 ( Main/Exploration ); précédent : 009A42; suivant : 009A44Aortic arch atheroma
Auteurs : Jorge A. Zavala [Australie] ; Pierre Amarrenco [France] ; Stephen M. Davis [Australie] ; Elizabeth F. Jones [Australie] ; Dennis Young [Australie] ; Malcolm R. Macleod [Australie, Royaume-Uni] ; Laura L. Horky [Australie] ; Geoffrey A. Donnan [Australie]Source :
- International Journal of Stroke [ 1747-4930 ] ; 2006-05.
English descriptors
- KwdEn :
- Amarenco, Aortic, Aortic arch, Aortic arch atheroma, Aortic atheroma, Aortic plaque, Aortic plaques, Arch, Arch atheroma, Aspirin, Atheroma, Atherosclerosis, Atherosclerotic, Atrial, Atrial fibrillation, Cardiol, Carotid, Carotid stenosis, Cerebral infarction, Cerebrovascular, Cerebrovascular disease, Cigarette smoking, Clopidogrel, Coll cardiol, Combination therapy, Cryptogenic stroke, Diabetes mellitus, Echocardiographic, Echocardiography, Embolic, Embolic events, Embolism, Fibrillation, High risk, Hypertension, Infarction, International journal, Ischaemic, Ischaemic stroke, Ischemic, Ischemic stroke, Journal compilation, Lacunar, Lacunar stroke, Mobile atheroma, Myocardial infarction, Natural history, Odds ratio, Peripheral embolism, Plaque, Prospective study, Recurrent stroke, Review article, Risk factor, Risk factors, Secondary prevention, Severe arch atheroma, Severe atheroma, Stenosis, Stroke, Stroke group, Stroke patients, Stroke prevention, Systemic embolization, Thoracic, Thoracic aorta, Transesophageal, Transesophageal echocardiographic study, Transesophageal echocardiography, Transient ischaemic attack, Tunick, Vascular events.
- Teeft :
- Amarenco, Aortic, Aortic arch, Aortic arch atheroma, Aortic atheroma, Aortic plaque, Aortic plaques, Arch, Arch atheroma, Aspirin, Atheroma, Atherosclerosis, Atherosclerotic, Atrial, Atrial fibrillation, Cardiol, Carotid, Carotid stenosis, Cerebral infarction, Cerebrovascular, Cerebrovascular disease, Cigarette smoking, Clopidogrel, Coll cardiol, Combination therapy, Cryptogenic stroke, Diabetes mellitus, Echocardiographic, Echocardiography, Embolic, Embolic events, Embolism, Fibrillation, High risk, Hypertension, Infarction, International journal, Ischaemic, Ischaemic stroke, Ischemic, Ischemic stroke, Journal compilation, Lacunar, Lacunar stroke, Mobile atheroma, Myocardial infarction, Natural history, Odds ratio, Peripheral embolism, Plaque, Prospective study, Recurrent stroke, Review article, Risk factor, Risk factors, Secondary prevention, Severe arch atheroma, Severe atheroma, Stenosis, Stroke, Stroke group, Stroke patients, Stroke prevention, Systemic embolization, Thoracic, Thoracic aorta, Transesophageal, Transesophageal echocardiographic study, Transesophageal echocardiography, Transient ischaemic attack, Tunick, Vascular events.
Abstract
Abstract Severe atheroma of the aortic arch has now been established as an important risk factor and mechanism for stroke and peripheral embolism. The odds ratio for stroke or peripheral embolism in patients with severe arch atheroma is greater than four, and for mobile atheroma it is greater than 12. The prevalence of severe arch atheroma among patients presenting with acute ischaemic stroke, at over 20%, is in the same order as that of atrial fibrillation and carotid atherosclerosis. In patients with ischaemic stroke for which no cause has been identified, it is reasonable to determine as to whether they have severe arch atheroma by performing a transoesophageal echocardiogram. Recurrent stroke is common in patients with aortic arch atheroma that are thicker than 4 mm or with mobile components, particularly in the elderly, cigarette smokers, and those with hypertension or diabetes. Patients found to have severe atheroma are at high risk of recurrent events (14·2% per year) and may, therefore, need an aggressive secondary prevention strategy. Currently, there is uncertainty as to what this should be, but either combination antiplatelet therapy (aspirin plus clopidogrel) or anticoagulation with warfarin (target INR 2·0–3·0) are commonly used. Which of these is most effective will be evident after the completion of the aortic arch related cerebral hazard trial.
Url:
DOI: 10.1111/j.1747-4949.2006.00026.x
Affiliations:
- Australie, France, Royaume-Uni
- Victoria (État), Écosse, Île-de-France
- Melbourne, Paris, Édimbourg
- Université d'Édimbourg, Université de Melbourne
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Le document en format XML
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Macleod</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>National Stroke Research Institute, Heidelbergh Heights, Vic.</wicri:regionArea><wicri:noRegion>Vic.</wicri:noRegion></affiliation><affiliation wicri:level="4"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Division of Clinical Neuroscience, University of Edinburgh, Edinburgh</wicri:regionArea><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region><settlement type="city">Édimbourg</settlement></placeName><orgName type="university">Université d'Édimbourg</orgName></affiliation></author><author><name sortKey="Horky, Laura L" sort="Horky, Laura L" uniqKey="Horky L" first="Laura L." last="Horky">Laura L. 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Donnan</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>National Stroke Research Institute, Heidelbergh Heights, Vic.</wicri:regionArea><wicri:noRegion>Vic.</wicri:noRegion></affiliation><affiliation wicri:level="4"><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine, University of Melbourne, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Australie</country></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">International Journal of Stroke</title><title level="j" type="alt">INTERNATIONAL JOURNAL OF STROKE</title><idno type="ISSN">1747-4930</idno><idno type="eISSN">1747-4949</idno><imprint><biblScope unit="vol">1</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="74">74</biblScope><biblScope unit="page" to="80">80</biblScope><biblScope unit="page-count">7</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2006-05">2006-05</date></imprint><idno type="ISSN">1747-4930</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1747-4930</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Amarenco</term><term>Aortic</term><term>Aortic arch</term><term>Aortic arch atheroma</term><term>Aortic atheroma</term><term>Aortic plaque</term><term>Aortic plaques</term><term>Arch</term><term>Arch atheroma</term><term>Aspirin</term><term>Atheroma</term><term>Atherosclerosis</term><term>Atherosclerotic</term><term>Atrial</term><term>Atrial fibrillation</term><term>Cardiol</term><term>Carotid</term><term>Carotid stenosis</term><term>Cerebral infarction</term><term>Cerebrovascular</term><term>Cerebrovascular disease</term><term>Cigarette smoking</term><term>Clopidogrel</term><term>Coll cardiol</term><term>Combination therapy</term><term>Cryptogenic stroke</term><term>Diabetes mellitus</term><term>Echocardiographic</term><term>Echocardiography</term><term>Embolic</term><term>Embolic events</term><term>Embolism</term><term>Fibrillation</term><term>High risk</term><term>Hypertension</term><term>Infarction</term><term>International journal</term><term>Ischaemic</term><term>Ischaemic stroke</term><term>Ischemic</term><term>Ischemic stroke</term><term>Journal compilation</term><term>Lacunar</term><term>Lacunar stroke</term><term>Mobile atheroma</term><term>Myocardial infarction</term><term>Natural history</term><term>Odds ratio</term><term>Peripheral embolism</term><term>Plaque</term><term>Prospective study</term><term>Recurrent stroke</term><term>Review article</term><term>Risk factor</term><term>Risk factors</term><term>Secondary prevention</term><term>Severe arch atheroma</term><term>Severe atheroma</term><term>Stenosis</term><term>Stroke</term><term>Stroke group</term><term>Stroke patients</term><term>Stroke prevention</term><term>Systemic embolization</term><term>Thoracic</term><term>Thoracic aorta</term><term>Transesophageal</term><term>Transesophageal echocardiographic study</term><term>Transesophageal echocardiography</term><term>Transient ischaemic attack</term><term>Tunick</term><term>Vascular events</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Amarenco</term><term>Aortic</term><term>Aortic arch</term><term>Aortic arch atheroma</term><term>Aortic atheroma</term><term>Aortic plaque</term><term>Aortic plaques</term><term>Arch</term><term>Arch atheroma</term><term>Aspirin</term><term>Atheroma</term><term>Atherosclerosis</term><term>Atherosclerotic</term><term>Atrial</term><term>Atrial fibrillation</term><term>Cardiol</term><term>Carotid</term><term>Carotid stenosis</term><term>Cerebral infarction</term><term>Cerebrovascular</term><term>Cerebrovascular disease</term><term>Cigarette smoking</term><term>Clopidogrel</term><term>Coll cardiol</term><term>Combination therapy</term><term>Cryptogenic stroke</term><term>Diabetes mellitus</term><term>Echocardiographic</term><term>Echocardiography</term><term>Embolic</term><term>Embolic events</term><term>Embolism</term><term>Fibrillation</term><term>High risk</term><term>Hypertension</term><term>Infarction</term><term>International journal</term><term>Ischaemic</term><term>Ischaemic stroke</term><term>Ischemic</term><term>Ischemic stroke</term><term>Journal compilation</term><term>Lacunar</term><term>Lacunar stroke</term><term>Mobile atheroma</term><term>Myocardial infarction</term><term>Natural history</term><term>Odds ratio</term><term>Peripheral embolism</term><term>Plaque</term><term>Prospective study</term><term>Recurrent stroke</term><term>Review article</term><term>Risk factor</term><term>Risk factors</term><term>Secondary prevention</term><term>Severe arch atheroma</term><term>Severe atheroma</term><term>Stenosis</term><term>Stroke</term><term>Stroke group</term><term>Stroke patients</term><term>Stroke prevention</term><term>Systemic embolization</term><term>Thoracic</term><term>Thoracic aorta</term><term>Transesophageal</term><term>Transesophageal echocardiographic study</term><term>Transesophageal echocardiography</term><term>Transient ischaemic attack</term><term>Tunick</term><term>Vascular events</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">Abstract Severe atheroma of the aortic arch has now been established as an important risk factor and mechanism for stroke and peripheral embolism. The odds ratio for stroke or peripheral embolism in patients with severe arch atheroma is greater than four, and for mobile atheroma it is greater than 12. The prevalence of severe arch atheroma among patients presenting with acute ischaemic stroke, at over 20%, is in the same order as that of atrial fibrillation and carotid atherosclerosis. In patients with ischaemic stroke for which no cause has been identified, it is reasonable to determine as to whether they have severe arch atheroma by performing a transoesophageal echocardiogram. Recurrent stroke is common in patients with aortic arch atheroma that are thicker than 4 mm or with mobile components, particularly in the elderly, cigarette smokers, and those with hypertension or diabetes. Patients found to have severe atheroma are at high risk of recurrent events (14·2% per year) and may, therefore, need an aggressive secondary prevention strategy. Currently, there is uncertainty as to what this should be, but either combination antiplatelet therapy (aspirin plus clopidogrel) or anticoagulation with warfarin (target INR 2·0–3·0) are commonly used. Which of these is most effective will be evident after the completion of the aortic arch related cerebral hazard trial.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Royaume-Uni</li></country><region><li>Victoria (État)</li><li>Écosse</li><li>Île-de-France</li></region><settlement><li>Melbourne</li><li>Paris</li><li>Édimbourg</li></settlement><orgName><li>Université d'Édimbourg</li><li>Université de Melbourne</li></orgName></list><tree><country name="Australie"><noRegion><name sortKey="Zavala, Jorge A" sort="Zavala, Jorge A" uniqKey="Zavala J" first="Jorge A." last="Zavala">Jorge A. Zavala</name></noRegion><name sortKey="Davis, Stephen M" sort="Davis, Stephen M" uniqKey="Davis S" first="Stephen M." last="Davis">Stephen M. Davis</name><name sortKey="Donnan, Geoffrey A" sort="Donnan, Geoffrey A" uniqKey="Donnan G" first="Geoffrey A." last="Donnan">Geoffrey A. Donnan</name><name sortKey="Donnan, Geoffrey A" sort="Donnan, Geoffrey A" uniqKey="Donnan G" first="Geoffrey A." last="Donnan">Geoffrey A. Donnan</name><name sortKey="Donnan, Geoffrey A" sort="Donnan, Geoffrey A" uniqKey="Donnan G" first="Geoffrey A." last="Donnan">Geoffrey A. Donnan</name><name sortKey="Horky, Laura L" sort="Horky, Laura L" uniqKey="Horky L" first="Laura L." last="Horky">Laura L. Horky</name><name sortKey="Jones, Elizabeth F" sort="Jones, Elizabeth F" uniqKey="Jones E" first="Elizabeth F." last="Jones">Elizabeth F. Jones</name><name sortKey="Macleod, Malcolm R" sort="Macleod, Malcolm R" uniqKey="Macleod M" first="Malcolm R." last="Macleod">Malcolm R. Macleod</name><name sortKey="Young, Dennis" sort="Young, Dennis" uniqKey="Young D" first="Dennis" last="Young">Dennis Young</name></country><country name="France"><region name="Île-de-France"><name sortKey="Amarrenco, Pierre" sort="Amarrenco, Pierre" uniqKey="Amarrenco P" first="Pierre" last="Amarrenco">Pierre Amarrenco</name></region></country><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Macleod, Malcolm R" sort="Macleod, Malcolm R" uniqKey="Macleod M" first="Malcolm R." last="Macleod">Malcolm R. Macleod</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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