Transesophageal echocardiography as a tool in the evaluation of patients with embolic disorders

Kronzon, Itzhak; Tunick, Paul A.

doi:10.1016/0033-0620(93)90021-5

Cited by 36 publications

(10 citation statements)

References 100 publications

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“…In previous decades, radiological imaging techniques were not developed sufficiently, and thus protruding and mobile atheromas in the aortic arch and the descending aorta that were visualized by TEE may have been missed by other radiological techniques including angiography and computerized tomography. 32 Even in a recent comparative study, computed tomographic angiography was found to have 53% sensitivity and 89% specificity in detecting aortic arch atheromas compared with TEE. 33 Although MRI and computed tomographic angiography are now emerging as powerful noninvasive tools, TEE still remains the gold standard and the first choice for screening aortic atheromas.…”

Section: Discussionmentioning

confidence: 92%

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Katsanos

Giannopoulos

Kosmidou

et al. 2014

Stroke

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This meta-analysis has adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic Background and Purpose-Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. Methods-We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. Results-We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. Conclusions-Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism. (Stroke. 2014;45:1764-1770.)

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Section: Discussionmentioning

confidence: 92%

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Katsanos

Giannopoulos

Kosmidou

et al. 2014

Stroke

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“…The patient awoke from surgery with a stroke. 42 Furthermore, patients with aortic arch plaque have far more emboli to the left brain and periphery than they do to the right brain. 8 This is true because the innominate artery (which supplies the right brain) is proximal to aortic arch plaque in most cases.…”

Section: Aortic Plaque and Atrial Fibrillationmentioning

confidence: 99%

Aortic Atherosclerotic Disease and Stroke

2006

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“…Apart from embolic phenomena, the possibility that atheroma of the superior aspect of the transverse segment of the aortic arch may impinge upon the outflow on either innominate of subclavian arteries, thus producing haemodynamic and in situ thrombolytic effects due to partial or complete vessel occlusion cannot be excluded. Embolic mechanisms have been more readily documented during procedures such as cardiac bypass sur gery [19], balloon pump installation or catheter studies [31], Whether the embolic material consists of fresh or old It thrombus, cholesterol or other atheromatous debris is dif ficult to ascertain from case to case and this may have implications in terms of likely success of therapy.…”

Section: The Mechanism Of Cerebral Ischaemiamentioning

confidence: 99%

“…Because there is only a limited ability to correlate patho logical change with in vivo images, the thrombotic versus atheromatous content of the images is difficult to deter mine. However, this has been done in a limited number of cases and surgical intervention has occurred and a reason able correlation between image and morphology has been achieved [31].…”

Section: Toe and The Assessment Of Arch Atheromamentioning

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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Transesophageal echocardiography as a tool in the evaluation of patients with embolic disorders

Cited by 36 publications

References 100 publications

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Complex Atheromatous Plaques in the Descending Aorta and the Risk of Stroke

Aortic Atherosclerotic Disease and Stroke

Aortic Arch Atheroma and Stroke

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