Complications of aortic atherosclerosis: Atheroemboli and thromboemboli

Abstract

Patients with severe aortic atherosclerosis are at high risk for stroke and other embolic complications. Therapy to prevent emboli from aortic plaque is not yet established. Therefore, patients with atherosclerosis or risk factors for embolic disease should be identified and treated aggressively. Aspirin, smoking cessation, and control of blood pressure and glucose are important. Retrospective data in patients with severe aortic plaque support the use of statins to prevent stroke. Iatrogenic embolization can occur as a result of aortic manipulation during invasive vascular procedures or cardiovascular surgery. The risks and benefits of these procedures must be carefully weighed, and alternate approaches should be considered for patients with severe aortic atherosclerosis. For those who require coronary artery bypass graft (CABG) surgery, off-pump CABG is an option. Prophylactic aortic arch atherectomy should not be routinely performed. Aortic filters or stenting have been introduced but have not yet been fully evaluated. For patients who require angiography and have severe descending aortic, aortic arch, or abdominal aortic plaque, it is possible that a brachial (rather than a femoral) approach may avoid embolic complications.

Cholesterol Embolization Syndrome

“…In the initial experience, CT seemed to underestimate the atheromatous plaque burden in the aorta compared with 2-dimensional TEE ( Figure 5). 20 In a series of 32 patients with a recent history of stroke or systemic emboli, the sensitivity and specificity of noncontrast dual-helical CT in comparison to TEE were 87% and 82%, respectively. 21 However, with recent technical advances, CT and MRI may now provide a less invasive and more complete evaluation of aortic atherosclerosis compared with 2-dimensional TEE.…”

Early Detection of Vulnerable Atherosclerotic Plaque for Risk Reduction of Acute Aortic Rupture and Thromboemboli and Atheroemboli Using Non-Obstructive Angioscopy

“…62 CT may underestimate the atheromatous plaque burden in the aorta compared with 2-D TEE. 67 Complex plaque, defined as plaque at least 4 mm thick or having a mobile component detected on TEE, has been considered more likely to cause embolic events. 68 Detection of thromboemboli and atheroemboli and distinguishing between them might play a role in risk stratification.…”

Severe Calcification of the Ascending Aorta Detected Incidentally in Patients Undergoing Cardiac Surgery

“…20 A case report determined death from multiple organ failure due to wide embolization detected by TEE of the aorta showing detaching plaques floating distally in blood circulation. 21,22 Another case of open heart surgery followed by a stroke reported a severe atheromatous plaque during an intraoperative TEE showing that a part of those atheromatous plaques was detached under visualization during cannulation of the aorta. 17 Many pre-and intraoperatively imaging modalities are used nowadays to detect the severity and extent of the atheromatous plaques of the aorta, such as contrast angiography, TEE, epiaortic ultrasound imaging, MRI, and CT.…”