Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
J Atheroscler Thromb. 2021 Jul 1;28(7):786-788. doi: 10.5551/jat.62890. Epub 2021 Apr 3.
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.
我们对 Suzuki 等人在《动脉粥样硬化与血栓形成杂志》上发表的文章《非瓣膜性心房颤动急性缺血性脑卒中患者的复杂主动脉弓粥样硬化》很感兴趣。作者表明，106 例伴有心房颤动（AF）的急性缺血性脑卒中患者中，有 38.7%经食管超声心动图（TEE）检查存在复杂主动脉弓斑块（CAP），这表明急性缺血性脑卒中伴 AF 的患者常存在 CAP。主动脉弓处的粥样硬化病变是缺血性脑卒中的原因之一。AF 患者发生急性缺血性脑卒中的原因不仅可能是由于 AF 导致的心源性栓塞，也可能是由于 CAP 导致的主动脉源性栓塞。对于伴有 AF 的脑卒中患者，应考虑同时存在 CAP 的可能性。非阻塞性全血管镜检查比 TEE 更有可能准确地检测到主动脉弓处的主动脉斑块，并且可能有助于诊断主动脉弓处的粥样斑块和栓塞物质。需要进一步的研究来阐明缺血性脑卒中的原因，并有望改善伴有 AF 的急性缺血性脑卒中患者的预后。
