Aortic arch calcification (AAC) may be a useful marker of atherosclerosis in patients with ESUS. Our objective is to examine the frequency and severity of AAC in ESUS patients and compare with other stroke subtypes.
We reviewed CT angiograms of 110 consecutive ESUS patients and performed semi-automated calcium scoring of the aortic arch between origins of great vessels. We divided non-zero scores into tertiles and compared clinical characteristics across these tertiles. We compared ESUS patients without AAC and ESUS patients in the highest AAC score tertile with patients who had other confirmed stroke subtypes [large artery atherosclerosis (LAA, n=224), small vessel disease (SVD, n=154) and cardioembolic (CE, n=310)].
Among 110 ESUS patients, we identified 62% with AAC (mean age 73, 57% female); 21% were in the 3rd tertile of AAC score. Patients with higher burden AAC were older, more often female, and had more often hypertension (HTN), coronary artery disease (CAD), and non-stenotic carotid plaques (table 1). Patients in the highest calcification tertile had more diabetes and higher cholesterol than CE patients, were more often female than LAA patients, and were more often female, had more CAD and left ventricular hypertrophy than SVD patients (table 2).
High aortic arch calcification burden was frequently observed in ESUS patients. Further data are needed to quantify the contribution of aortic arch atheromas as an embolic source in the ESUS population. However, our findings support aggressive medical management of ESUS patients with a concomitant high burden of aortic arch disease.