Multidetector CT evaluation of various aortic diseases: diagnostic tips, pitfalls, and remedies for imaging artifacts

Clinical significance of intraluminal atheroma in patients with ascending and arch aneurysm

BACKGROUND

Little is known about the clinical significance of intraluminal atheroma (ILA) in ascending and arch aneurysm (Asc-ArcA) regarding aneurysm expansion and associated cardiovascular events.

METHODS

We retrospectively investigated 70 consecutive patients with Asc-ArcA who underwent serial multidetector computed tomography between 2004 and 2011. We evaluated the diameter of the aneurysm, as well as the presence and characteristics of ILA. We also evaluated the characteristics of atheroma in terms of the presence of high-risk plaque (>4 mm in plaque thickness), vulnerable plaque (<60 HU in density), ulcerated plaque (extension of the contrast medium beyond the vascular lumen into the surrounding plaque with >3 mm orifice), and complex plaque (having all three characteristics). The annual expansion rate of Asc-ArcA and factors associated with cardiovascular events were evaluated.

RESULTS

During a median of 47 months of follow-up, cryptogenic stroke occurred in 13 patients (18.6%). Univariate and multivariate logistic regression analyses revealed the presence of ILA as an independent predictor for cryptogenic stroke. Cryptogenic stroke occurred in all 5 patients with complex atheroma. The annual expansion rate of Asc-ArcA was not significantly associated with the occurrence of cryptogenic stroke.

CONCLUSIONS

In patients with low to intermediate risk sized Asc-ArcA, ILA, especially complex atheroma, is strongly associated with cryptogenic stroke. Thus, the presence and characteristics of ILA within Asc-ArcA should be carefully evaluated for the prevention of adverse events.