Recognition and embolic potential of intraaortic atherosclerotic debris

Abstract

Atherosclerotic disease of the thoracic aorta is common in the elderly and patients with clinical coronary artery disease. Although embolization can occur from atherosclerotic debris within the thoracic aorta, it is not commonly considered in the differential diagnosis of the source of a systemic embolism. In the current study, the prevalence, clinical significance and embolic potential of intraaortic atherosclerotic debris as detected by transesophageal echocardiography was determined. Intraaortic atherosclerotic debris was identified in 38 (7%) of 556 patients undergoing transesophageal echocardiography. An embolic event occurred among 11 (31%) of the 36 study patients with intraaortic atherosclerotic debris. The incidence of an embolic event was higher when the debris was pedunculated and highly mobile (8 [73%] of 11 patients) than when it was layered and immobile (3 [12%] of 25 patients) (p less than 0.002). Among 15 patients undergoing an invasive procedure of the aorta, the incidence of embolism was 27%. In conclusion, in a patient with an embolic event, the thoracic aorta should be considered as a potential source. Transesophageal echocardiography can reliably detect intraaortic atherosclerotic debris, and when it is identified, an invasive aortic procedure should be avoided if possible.

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

“…Aortic thrombus was defined as laminated deposition along the intimal surface, with variable echogenicity, and which may be associated with mobile lesions. 15,16 Echocardiograms were stored on videotape and categorized according to a modified Hart classification. 17,18 Consequently, echocardiographic abnormalities were considered cardiac high and potential risk factors for embolism ( Figure 2).…”

Two Cases of Protruding Atherosclerotic Plaque with Mobile Projections in the Aortic Arch.

“…Wecannot definitely conclude that the ulcerated plaque with mobile projections was responsible for the cerebral emboli in both of these patients. As Karalis et al have stated (4), when atherosclerotic plaques are pedunculated and highly mobile, the incidence of an embolic events is high. In the present two cases , the atherosclerotic plaques were pedunculated and highly mobile, and we could not find any other cause of cerebral embolism.…”

“…However, TEE enables us to repeatedly investigate the thoracic aorta in a noninvasive manner. In fact, several studies focusing on the thoracic aorta as a possible embolic source have been published recently (1)(2)(3)(4)(5)(6)(7)(8). Amarencoet al (1) defined aortic ulceration as a disruption of the intimal surface that was visible on macroscopicexamination.…”

Aortic Atheromatous Lesions Developed in APA Hamsters with Streptozotocin induced Diabetes: A New Animal Model for Diabetic Atherosclerosis. 1. Histopathological Studies.

“…Fatty masses sometimes found at 26 WAI are likely to separate from the aortic walls, resulting in embolisms in smaller arteries or arterioles [4,14,24,41,42]. Large plaques consisting of many FCs and SMCs in the aorta and carotid artery bifurcation walls or many small fatty plaques in the carotid arteries possibly decrease the blood flow in the carotid arteries and are suspected of causing brain ishchemia and stroke [9,20,21,44].…”