Protruding aortic arch thrombus: Treatment with minimally invasive surgical approach

Schneiderman, Jacob; Feinberg, Micha S.; Schwammenthal, Ehud; Tenenbaum, Alex; Garniak, A; Morag, B; Walden, Raphael; Heldenberg, Eitan; Fenigstein, Hana; Adar, R

doi:10.1016/j.jvs.2004.09.014

Cited by 20 publications

(15 citation statements)

References 20 publications

(16 reference statements)

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“…23 There are only case reports of successful ultima ratio treatment options such as aortic endarterectomy 24 or aortic balloon thrombectomy. 25 The ongoing Aortic arch Related Cerebral Hazard trial of 1500 patients comparing clopidogrel + aspirin versus warfarin may contribute substantial information towards the optimal management of aortic plaques.…”

Section: Discussionmentioning

confidence: 99%

Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques?

Harloff

Handke²,

Geibel³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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Objectives: This study investigated (a) the hypothesis that stroke patients with aortic atheroma would show comparable atherosclerotic changes in the carotid arteries, which are easily accessible for ultrasound evaluation and (b) the possibility of carotid duplex sonography as a replacement for transoesophageal echocardiography (TEE) for the exclusion or prediction of relevant aortic plaques. Methods: In 301 consecutive patients (mean age 62 years) with acute cerebral ischaemia, two dimensional ultrasound measurements were taken of common carotid artery intima media thickness (IMT) and maximal plaque area (PA) and the local degree of internal carotid artery (ICA) stenosis were determined. Maximal aortic wall thickness (AWT) was assessed by TEE. Results: An IMT (0.9 mm yielded a negative predictive value (NPV) of 95.8% for exclusion of aortic atheromas >4 mm and an NPV of 100% for the exclusion of aortic thrombi. However, positive predictive value of IMT .0.9 mm was low (29.6%), increasing only slightly in the presence of carotid plaques (33%). Incidence of aortic thrombi was significantly higher with >50% compared with ,50% ICA stenosis (11.3% v 3.9%, respectively). IMT and PA correlated moderately with AWT (r = 0.47, r = 0.53, respectively; p,0.001). Systolic blood pressure, coronary heart disease and peripheral artery disease, increased IMT, and ICA stenosis >50% were independently related to AWT >4 mm. Conclusions: A high NPV of normal carotid ultrasound does not support routine TEE for the exclusion of complex aortic plaques as a high risk source of cerebral embolism. However, in patients with carotid atherosclerosis, particularly in those with ICA stenosis >50%, TEE should be performed to exclude an additional high risk source for stroke.

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Section: Discussionmentioning

confidence: 99%

Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques?

Harloff

Handke²,

Geibel³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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“…7 Although there have been several reports on the use of preoperative TEE in the diagnosis of a thoracic aortic thrombus, the use of intraoperative TEE to guide surgical management of aortic thrombus has been limited to endovascular techniques. 1,2,6,8,9 In our case, the proximity of the stalk of the thrombus to the left subclavian artery made determining the area of placement of the cross-clamp critical. Because of the intimate relationship of the thoracic esophagus with the thoracic aorta, we were able to precisely pinpoint the location of the stalk; the surgeon was then easily able to palpate the TEE transducer in the esophagus and note its relationship to the thoracic aorta.…”

Section: Discussionmentioning

confidence: 76%

Transesophageal Echocardiography–Guided Aortic Thrombectomy in a Patient With a Mobile Thoracic Aortic Thrombus

Krishnamoorthy

Bhatt

Nicolau

et al. 2011

Semin Cardiothorac Vasc Anesth

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Thoracic aortic thrombi are a well-known cause of distal embolic phenomena. There is a paucity of case reports because of the rarity of this condition, and thus clear management guidelines are lacking. The authors present a case of a mobile thoracic aortic thrombus managed by a surgical approach. This report demonstrates how intraoperative transesophageal echocardiography (TEE) proved to be critical in guiding surgical management. The utility of TEE in the diagnosis and management of aortic thrombi is also discussed. In addition, currently reported management strategies for this complex condition are reviewed.

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“…Aortic mural thrombus is an uncommon entity that has been reported to develop primarily or secondarily due to multiple underlying medical conditions including acute pancreatitis as in the present case and administration of steroid therapy 1 2. Previous small-scale studies have indicated that conservative therapy, endovascular balloon thrombectomy, endovascular stent graft coverage or surgical removal could be a treatment option whereas no standardised consensus has been established due to the rarity and heterogeneity of this disease 1–4. When we discuss the treatment of aortic mural thrombus, evaluation of thrombus mobility is of fundamental importance in preventing embolic complications.…”

Section: Descriptionmentioning

confidence: 80%

Aortic mural thrombus visualised on transoesophageal echocardiography

et al. 2019

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Protruding aortic arch thrombus: Treatment with minimally invasive surgical approach

Abstract: TEE-guided aortic balloon thrombectomy used in 6 procedures was effectively completed without visceral or peripheral ischemic complications. It enabled removal of the life-threatening source of emboli from the proximal aorta, thereby averting the need of major aortic surgery.

Cited by 20 publications

References 20 publications

Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques?

Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques?

Transesophageal Echocardiography–Guided Aortic Thrombectomy in a Patient With a Mobile Thoracic Aortic Thrombus

Aortic mural thrombus visualised on transoesophageal echocardiography

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