Mortality and recurrence in acute ischemic stroke of all etiologies according to ultrasonographic assessment of carotid and aortic arch plaques: a prospective study

Abstract Carotid duplex ultrasound helps to determine the degree of stenosis or occlusion and characterizes plaque composition and vulnerability, which is crucial for stroke risk stratification. Recurrent ischemic stroke poses a significant risk to individuals, with about one-third of stroke survivors experiencing a repeat event within 5 years. Large-artery atherosclerosis, such as carotid, aortic, and femoral arteries, further increases the risk of recurrent strokes and influences prognosis. Moreover, stroke can result in worse outcomes, including higher morbidity, mortality, and cardiovascular complications in the 3 years after. In recent years, a simple, non-invasive ultrasound evaluation through the suprasternal notch has been proposed for identifying atherosclerosis of the aortic arch, with good sensitivity and specificity. Despite its non-invasive nature and growing clinical relevance, the prognostic utility of aortic arch ultrasound in the context of ischemic stroke of all etiologies remains underexplored. This study aims to evaluate the link between ultrasound characteristics of aortic and carotid plaques and the risk of mortality and recurrent stroke among patients with acute ischemic stroke. One hundred-eight patients with first-episode acute ischemic stroke, a mean age of 71.3 (13.4) years, underwent carotid Duplex and transthoracic aortic arch ultrasounds. They were followed up every 6 months for 3 years. The results revealed that while carotid plaques and stenosis were not significantly associated with recurrent stroke, the absence of plaques was associated with higher survival rates (p = 0.008). Conversely, the simultaneous presence of plaques in both the common and internal carotid arteries was associated with increased mortality (p = 0.004). Finally, echo-lucent intimal lesions, according to the Gray–Weale classification, are considered high-risk plaques and showed good sensitivity (89.6%) but poor specificity in predicting outcomes at 3 years (AUC = 0.63, p = 0.0164). These findings suggest that routine non-invasive ultrasound evaluation of both carotid and aortic arch can be beneficial in stratifying patients for secondary prevention and improving stroke care.