Event Abstract

Cardioembolic Mimicry: A Case Series

  • 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