Cardioembolic Mimicry: A Case Series
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1
West Virginia University, United States
Objective: We hypothesize that atherosclerotic plaque in the proximal subclavian artery is a possible source of
ischemic strokes that would otherwise be considered cryptogenic or cardioembolic.
Background: It is well known that cardioembolism causes both anterior and posterior ischemic stroke. However,
an embolus from a lesser known location may initially be mistaken as cardioembolic in origin. Based on
multidirectional 3D MRI and color-Doppler-guided pulsed-Doppler velocity mapping, we know that retrograde
blood flood exists at the level of the aortic arch and the descending aorta.
Design/Methods: We evaluated patients with acute stroke who had CT intracranial, extra-cranial studies and
MRI brain. Territory and embolic pattern of brain ischemia were retrospectively reviewed. (1) Embolic risk from the
proximal subclavian was present. (2) Embolic pattern of brain ischemia in a territory supplied by the vertebral and
common carotids arteries.
Results: 3 patients had atherosclerotic diseases noted at the origin of the proximal subclavian. Of these patients,
2 had left subclavian involvement and 1 had right subclavian involvement. Of the patients with left subclavian
involvement, 1 had a partially adherent intraluminal thrombus in the subclavian artery proximal to the vertebral
artery. The other had an extensive non-calcified atherosclerotic plaque within the subclavian artery with moderate
non-calcified atherosclerotic plaque in the vertebral artery. The 3rd patient had an occlusion of the right proximal
subclavian.
Conclusions: Atherosclerotic plaques in the subclavian artery were detected by CTA and/or angiography in
patients with ischemic infarcts in both anterior and posterior circulations. The presence of concurrent acute
ischemic stroke and subclavian atherosclerosis could be another source of embolic phenomenon via retrograde
flow provoking infarction in addition to the more established cardioembolic sources. Correctly identifying
symptomatic subclavian atherosclerotic disease could have a direct implication on secondary stroke prevention
with revascularization procedures or optimal medical management.
References
Bogren, Hugo G., and Michael H. Buonocore. "Blood flow measurements in the aorta and major arteries with MR
velocity mapping." Journal of Magnetic Resonance Imaging 4.2 (1994): 119-130.
Svedlund, S., et al. "Retrograde blood flow in the aortic arch determined by transesophageal Doppler ultrasound."
Cerebrovascular Diseases 27.1 (2009): 22-28.
Keywords:
Stroke,
vascular,
Cardioembolic,
Subclavian,
Atherosclerosis
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Vu
PT and
Adcock
A
(2018). Cardioembolic Mimicry: A Case Series.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00044
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Received:
12 Feb 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Phong T Vu, West Virginia University, Morgantown, United States, phongt_vu@yahoo.com
Dr. Amelia Adcock, West Virginia University, Morgantown, United States, akadcock@hsc.wvu.edu