Multiple emboli from a large aortic arch thrombus in a patient with thrombotic diathesis

Tunick, Paul A.; Lackner, Henriette; Katz, Edward S.; Alfred, Culliford T.; Giangola, Gary; Kronzon, Itzhak

doi:10.1016/0002-8703(92)90955-u

Cited by 69 publications

(20 citation statements)

References 7 publications

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“…Several studies have warned that protruding atherosclerotic plaques in the proximal aorta are associated with cerebral infarctions and represent a potential embolic source [3, 4, 5, 6, 7, 8, 9, 10, 11, 19, 20, 21, 22, 23, 24]. However, few of them have focused on cryptogenic strokes, where AAP may have an important role in the cause of ischaemic events.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerotic Aortic Arch Plaques in Cryptogenic Stroke: A Microembolic Signal Monitoring Study

Castellanos¹,

Serena²,

Segura³

et al. 2001

Eur Neurol

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Background and Purpose: To find out the prevalence of relevant atherosclerotic plaques in the aortic arch and their potential role as a source of embolism in cryptogenic stroke. Methods: We performed a transoesophageal echocardiography (TEE) on 49 patients with cryptogenic stroke from a total series of 212 non-selected patients with acute ischaemic stroke studied prospectively by cranial computed tomography (CT), colour-duplex and transcranial Doppler (TCD) sonography with micro-embolic signal (MES) monitoring. Cryptogenic stroke was diagnosed in those patients without carotid or intracranial stenosis >50%, nor lacunar or cardio-embolic strokes. We defined relevant plaques as those ≧4 mm thick located in the ascending aorta or proximal arch. Results: Twenty-three patients (46.9%) had atherosclerotic aortic plaques (AAP): 3 in the ascending aorta (in 1 ≧4 mm), 11 in the proximal aortic arch (in 4 ≧4 mm) and 9 in the descending aorta (in 5 ≧4 mm). Hence, 5 patients (10.2%) had relevant plaques. Aortic plaques were significantly related to older age (p < 0.001) and male gender (p = 0.042). A carotid artery stenosis <50% was found in 39% of patients with AAP and in 8% of those without AAP (p = 0.009). MES were detected in 3 patients with plaques ≧4 mm thick, but not in those without AAP or with AAP <4 mm thick (p = 0.006). Conclusion: Although few patients with cryptogenic stroke had relevant plaques in our non-selected population, our results support the hypothesis that relevant aortic plaques have embolic potential.

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Section: Discussionmentioning

confidence: 99%

Atherosclerotic Aortic Arch Plaques in Cryptogenic Stroke: A Microembolic Signal Monitoring Study

Castellanos¹,

Serena²,

Segura³

et al. 2001

Eur Neurol

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“…Case reports of 2 such patients who underwent surgery documented that these mobile lesions were in fact thrombi superimposed on atherosclerotic plaque. 44,45 In one of these patients, red thrombi were seen both superimposed on the aortic plaque and in the specimen removed from the femoral artery where it had embolized (Figure 2).…”

Section: Pathological Correlationsmentioning

confidence: 99%

“…87 However, there have been case reports of successful aortic endarterectomy in a few desperate cases of recurrent embolization from a large aortic thrombus superimposed on plaque. 44,45 In another case, the aortic arch was successfully replaced in a patient who had recurrent embolization and plaque-associated aortic arch thrombi. 105 To date, there have been no randomized studies that evaluate these surgical approaches compared with medical therapy.…”

Section: Primary Surgical Therapymentioning

confidence: 99%

Aortic Atherosclerotic Disease and Stroke

2006

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“…[1][2][3][4][5][6][7][8][9] In these studies, a wall thickness Ն3 to 5 mm, the presence of ulceration, or the presence of a mobile aortic arch plaque was found to be associated with embolic brain infarction. Amarenco et al 8 found that ulcerated plaques at the aortic arch are independently associated with brain infarction of unknown cause.…”

mentioning

confidence: 91%

Aortic Arch Atherosclerotic Lesions and the Recurrence of Ischemic Stroke

Fujimoto

Yasaka

Otsubo

et al. 2004

Stroke

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Background and Purpose-Aortic arch atherosclerotic lesions are often associated with embolic brain infarction. We investigated the relationship between stroke recurrence and the characteristics of aortic arch atherosclerotic lesions. Methods-Among 487 stroke patients who underwent transesophageal echocardiography, 283 patients with brain embolism diagnosed without significant occlusive lesions (Ն50%) in their cerebral arteries were included in this study.We measured the intima-media thickness (IMT) and evaluated the extension and mobility of the aortic arch atherosclerotic lesions. During a mean follow-up period of 3.4 years, we investigated the relationship between stroke recurrence and the various characteristics of the aortic arch atherosclerotic lesions. Results-An IMT Ն4.0 mm was found in 67 patients (25.3%). In 51 of these patients, the aortic lesions extended to the origin of the branches of the arch. Recurrences of cerebral ischemic events were found in 32 patients (recurrence group) and not in the other 251 (nonrecurrence group). Aortic atheroma Ն4.0 mm (41% versus 22%), aortic atheroma extending to the branches (63% versus 39%), and both (38% versus 16%) were more frequently seen in the recurrence group than in the nonrecurrence group (PϽ0.05, PϽ0.1, PϽ0.01, respectively). After adjustment for age and the presence of hypertension, an aortic atheroma that was Ն4.0 mm as well as extending to the branches was found to be an independent predictor of ischemic stroke recurrence (hazard ratioϭ2.42, PϽ0.05). Conclusions-Stroke recurrence is associated with the severity of the atheroma (IMT Ն4.0 mm) and plaque extension to the branches.

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Multiple emboli from a large aortic arch thrombus in a patient with thrombotic diathesis

Cited by 69 publications

References 7 publications

Atherosclerotic Aortic Arch Plaques in Cryptogenic Stroke: A Microembolic Signal Monitoring Study

Atherosclerotic Aortic Arch Plaques in Cryptogenic Stroke: A Microembolic Signal Monitoring Study

Aortic Atherosclerotic Disease and Stroke

Aortic Arch Atherosclerotic Lesions and the Recurrence of Ischemic Stroke

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