Disappearance of a large intraaortic mass in a patient with prior systemic embolization

Freedberg, Robin S.; Tunick, Paul A.; Culliford, Alfred T.; Tatelbaum, Ronald J; Kronzon, Itzhak

doi:10.1016/0002-8703(93)91026-b

Cited by 28 publications

(9 citation statements)

References 12 publications

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“…Likewise, it has been described the disappearance of these mobile lesions after anticoagulation [42, 43] and thrombolysis [44]. The most remarkable common finding in all these observational or retrospective studies in patients with stroke or peripheral embolism is the high prevalence of atherosclerosis of the aortic arch (between 20% and 30%), which results of similar (or even greater) magnitude than the prevalence of carotid artery stenosis or atrial fibrillation in patients with stroke [5, 28, 45].…”

Section: Prevalence Of Aortic Arch Atheroma In Patients With Strokementioning

confidence: 98%

Complex Atheromatosis of the Aortic Arch in Cerebral Infarction

Capmany

Ibanez²,

Pesquer³

2010

CCR

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In many stroke patients it is not possible to establish the etiology of stroke. However, in the last two decades, the use of transesophageal echocardiography in patients with stroke of uncertain etiology reveals atherosclerotic plaques in the aortic arch, which often protrude into the lumen and have mobile components in a high percentage of cases. Several autopsy series and retrospective studies of cases and controls have shown an association between aortic arch atheroma and arterial embolism, which was later confirmed by prospectively designed studies. The association with ischemic stroke was particularly strong when atheromas were located proximal to the ostium of the left subclavian artery, when the plaque was ≥ 4 mm thick and particularly when mobile components are present. In these cases, aspirin might not prevent adequately new arterial ischemic events especially stroke. Here we review the evidence of aortic arch atheroma as an independent risk factor for stroke and arterial embolism, including clinical and pathological data on atherosclerosis of the thoracic aorta as an embolic source. In addition, the impact of complex plaques (≥ 4 mm thick, or with mobile components) on increasing the risk of stroke is also reviewed. In non-randomized retrospective studies anticoagulation was superior to antiplatelet therapy in patients with stroke and aortic arch plaques with mobile components. In a retrospective case-control study, statins significantly reduced the relative risk of new vascular events. However, given the limited data available and its retrospective nature, randomized prospective studies are needed to establish the optimal secondary prevention therapeutic regimens in these high risk patients.

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Section: Prevalence Of Aortic Arch Atheroma In Patients With Strokementioning

confidence: 98%

Complex Atheromatosis of the Aortic Arch in Cerebral Infarction

Capmany

Ibanez²,

Pesquer³

2010

CCR

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“…Aortic atheromas are characterized by an irregular intimal thickening of at least 2 mm, with increased echogenicity on TEE 3 . They often have superimposed mobile components, which are thrombi that have been shown to disappear with heparin, warfarin, or thrombolysis 4–6 . The morphology of aortic atheromatous plaques is dynamic, with frequent formation and resolution of mobile components 7 .…”

Section: Morphology and Classificationmentioning

confidence: 99%

REVIEW: Aortic Atheromas: Current Concepts and Controversies—A Review of the Literature

2007

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The frequent use of transesophageal echocardiogram (TEE) has led to the increased recognition of aortic atheromas. Retrospective and prospective follow-up studies have reported an association between aortic atheromas and stroke in the high-risk patient population, with complex plaques being more likely to embolize than simple plaques. However, TEE-based studies in the low-risk cohorts have failed to show a similar association. There is growing body of evidence suggesting that aortic atheroma is a marker of generalized atherosclerosis. Although magnetic resonance (MR) imaging and computed tomography (CT) scan are emerging as a powerful noninvasive tool for characterization of aortic atheromas, TEE is the imaging modality of choice. Currently, treatment of aortic atheromas is not well defined, and mixed outcomes have been reported for anticoagulation therapy with warfarin. Statins appear promising based on their plaque stabilization properties. However, there are no randomized control trials to establish the role of both anticoagulation and statins in patients with aortic atheromas, and are warranted in the future.

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“…Clearly, the approach will depend upon the clinical setting and the morpholgy documented by TOE; for example, recurrent and clinical ly significant embolism with a large, mobile and protrud ing piece of atheroma seen on TOE is likely to lead to a more invasive approach. More benign approaches include use of antiplatelet agents such as Aspirin [35] to prevent further embolic events or warfarin if recurrence of emboli occurs [31,36]. There have been reports of the use of thrombolysis [37] to dissolve clot and even surgical endar terectomy of large protruding atheromatous plaques in extreme cases [10,12].…”

Section: Managementmentioning

confidence: 99%

Aortic Arch Atheroma and Stroke

Donnan

Jones

1995

Cerebrovasc Dis

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The development of transoesophageal echocardiography as a relatively non-invasive means of imaging the aortic arch has led to the discovery of this region as a potential cause of stroke. There is in vivo and autopsy evidence that aortic arch atheroma is an independent risk factor for ischaemic stroke and that the risk is of the same order of magnitude as the well established risk factors such as hypertension, carotid stenosis and atrial fibrillation. The most common mechanism of stroke development is probably by virtue of embolic debris lodging within the cerebral circulation. Transoesophageal echocardiography as a means of detecting aortic arch atheroma is indicated in patients with embolic stroke in whom no obvious source of embolism from large arteries or heart can be found. While there is no consensus on how best to manage patients with aortic arch atheroma in a primary or secondary prevention setting, antiplatelet therapy, anticoagulants, thrombolytic agents and surgery have been suggested or used. Further improvements in non-invasive imaging of the aortic arch are likely to lead to a better understanding of its place in the genesis of ischaemic stroke and pave the way for trials of therapy.

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Disappearance of a large intraaortic mass in a patient with prior systemic embolization

Cited by 28 publications

References 12 publications

Complex Atheromatosis of the Aortic Arch in Cerebral Infarction

Complex Atheromatosis of the Aortic Arch in Cerebral Infarction

REVIEW: Aortic Atheromas: Current Concepts and Controversies—A Review of the Literature

Aortic Arch Atheroma and Stroke

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