Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Kronzon, I.    Tunick, P. A.    Related Articles in PubMed    PubMed Citation    PubMed

UPDATE

Atheromatous Disease of the Thoracic Aorta: Pathologic and Clinical Implications

Itzhak Kronzon, MD, and Paul A. Tunick, MD

15 April 1997 | Volume 126 Issue 8 | Pages 629-637

Purpose: To review recent developments in the diagnosis, clinical epidemiology, pathology, and management of atherosclerosis of the thoracic aorta, especially atherosclerosis of the thoracic aorta as a source of embolization.

View larger version (87K): [in this window] [in a new window]   Figure 4. Microscopic section of an atheroma removed from an aortic arch. The intimal plaque (P) and the superimposed thrombus (T) are shown. The patient from whom the atheroma was taken was a 53-year-old woman who had recently had a stroke, had an embolus of the right arm, and had bilateral leg emboli despite anticoagulation therapy [19].

 
Data Sources: MEDLINE searches, bibliographies of published papers, and consultation with experts in the field.

Study Selection: English-language publications on atherosclerosis of the thoracic aorta were selected.

Data Synthesis: During the last 6 years, the increasing use of transesophageal echocardiography has shown that atherosclerotic plaque in the thoracic aorta is a source of otherwise unexplained embolic events, including stroke, transient ischemic attack, and peripheral emboli. Retrospective studies have documented a strong independent association between larger lesions (4 mm to 5 mm) and previous embolic disease, and prospective studies have shown that patients with these lesions have a high risk for future events (in one study, the risk for stroke was 12%; in another, the risk for cerebral or peripheral events was 33% in a follow-up period of just 14 months). These lesions also pose a serious risk for embolization caused by manipulation of the aorta during catheterization, intra-aortic balloon-pump placement, and cannulation of the aorta for heart surgery. Pathologic examination has shown atherosclerotic plaque, often with superimposed thrombi that account for the mobile components seen on transesophageal echocardiography. The management of patients who have atherosclerotic lesions in the thoracic aorta has not been determined prospectively. However, anticoagulation may help prevent emboli, as it does for patients who have thrombi in other locations, such as the left atrium and the left ventricle.

Conclusions: Protruding atherosclerotic lesions in the thoracic aorta, often with superimposed mobile thrombi, are an important cause of embolic disease. Transesophageal echocardiography should be considered in the work-up of patients who have unexplained embolic events.

Author and Article Information

From New York University Medical Center, New York, New York.
Acknowledgment: The authors thank Dr. John Scholes for providing the pathologic evaluation and the photograph of the intimal plaque and superimposed thrombus in Figure 4.
Requests for Reprints: Paul A. Tunick, MD, Non-Invasive Cardiology Laboratory, New York University Medical Center, 560 First Avenue, New York, NY 10016.
Current Author Addresses: Drs. Kronzon and Tunick: Non-Invasive Cardiology Laboratory, New York University Medical Center, 560 First Avenue, New York, NY 10016.

This article has been cited by other articles:

				Y. Ueno, K. Kimura, Y. Iguchi, K. Shibazaki, T. Inoue, N. Hattori, and T. Urabe Mobile Aortic Plaques Are a Cause of Multiple Brain Infarcts Seen on Diffusion-Weighted Imaging Stroke, September 1, 2007; 38(9): 2470 - 2476. [Abstract] [Full Text] [PDF]

				I. Kronzon and P. A. Tunick Aortic Atherosclerotic Disease and Stroke Circulation, July 4, 2006; 114(1): 63 - 75. [Full Text] [PDF]

				J. C. Hueb, S. G. Zanati, K. Okoshi, C. N. Raffin, L. V. de Arruda Silveira, and B. B. Matsubara Association Between Atherosclerotic Aortic Plaques and Left Ventricular Hypertrophy in Patients With Cerebrovascular Events Stroke, April 1, 2006; 37(4): 958 - 962. [Abstract] [Full Text] [PDF]

				P. Boivie, M. Hansson, and K. G. Engstrom Intraluminal aortic manipulation by means of intra-aortic filter, cannulation, and external clamp maneuvers evaluated versus dislodged embolic material J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 283 - 289. [Abstract] [Full Text] [PDF]

				Y. P. Liew and J. R Bartholomew Atheromatous embolization Vascular Medicine, November 1, 2005; 10(4): 309 - 326. [Abstract] [PDF]

				S. F. Aranki, M. Nathan, P. Shekar, G. Couper, R. Rizzo, and L. H. Cohn Hypothermic Circulatory Arrest Enables Aortic Valve Replacement in Patients With Unclampable Aorta Ann. Thorac. Surg., November 1, 2005; 80(5): 1679 - 1687. [Abstract] [Full Text] [PDF]

				R. V. Milani, C. J. Lavie, Y. E. Gilliland, M. M. Cassidy, and J. A. Bernal Overview of Transesophageal Echocardiography for the Chest Physician Chest, September 1, 2003; 124(3): 1081 - 1089. [Abstract] [Full Text] [PDF]

				P. Lochow, A. Schwartzbard, J. Guest, C. Ripps, D. Matalon, R. Gambetta, P. A. Tunick, and S. Sedlis Elevated Prothrombin and Activated Protein C Resistance in Patients with Thoracic Aortic Atheroma Angiology, July 1, 2002; 53(4): 423 - 428. [Abstract] [PDF]

				A. Gerdes, T. Hanke, and H.-H Sievers In vitro hydrodynamics of the Embol-X cannula Perfusion, March 1, 2002; 17(2): 153 - 156. [Abstract] [PDF]

				M. A. Borger, J. Ivanov, R. D. Weisel, V. Rao, and C. M. Peniston Stroke during coronary bypass surgery: principal role of cerebral macroemboli Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 627 - 632. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, B. W. Lytle, V. Hoang, D. M. Cosgrove, M. K. Banbury, P. M. McCarthy, J. F. Sabik, G. B. Pettersson, N. G. Smedira, and E. H. Blackstone The atherosclerotic aorta at aortic valve replacement: Surgical strategies and results J. Thorac. Cardiovasc. Surg., November 1, 2000; 120(5): 957 - 965. [Abstract] [Full Text] [PDF]

				Z. A. Fayad, T. Nahar, J. T. Fallon, M. Goldman, J. G. Aguinaldo, J. J. Badimon, M. Shinnar, J. H. Chesebro, and V. Fuster In Vivo Magnetic Resonance Evaluation of Atherosclerotic Plaques in the Human Thoracic Aorta : A Comparison With Transesophageal Echocardiography Circulation, May 30, 2000; 101(21): 2503 - 2509. [Abstract] [Full Text] [PDF]

				A. Gerdes, E. Joubert-Hubner, K. Esders, and H.-H. Sievers Hydrodynamics of aortic arch vessels during perfusion through the right subclavian artery Ann. Thorac. Surg., May 1, 2000; 69(5): 1425 - 1430. [Abstract] [Full Text] [PDF]

				E. J. Topol and J. S. Yadav Recognition of the Importance of Embolization in Atherosclerotic Vascular Disease Circulation, February 8, 2000; 101(5): 570 - 580. [Full Text] [PDF]

				H. J. Willens and K. M. Kessler Transesophageal Echocardiography in the Diagnosis of Diseases of the Thoracic Aorta* : Part II--Atherosclerotic and Traumatic Diseases of the Aorta Chest, January 1, 2000; 117(1): 233 - 243. [Abstract] [Full Text] [PDF]

				J. L. Blackshear, L. A. Pearce, R. G. Hart, M. Zabalgoitia, A. Labovitz, R. W. Asinger, and J. L. Halperin Aortic Plaque in Atrial Fibrillation : Prevalence, Predictors, and Thromboembolic Implications Stroke, April 1, 1999; 30(4): 834 - 840. [Abstract] [Full Text] [PDF]

				R. C. King, R. C. Kanithanon, K. S. Shockey, W. D. Spotnitz, C. G. Tribble, and I. L. Kron Replacing the atherosclerotic ascending aorta is a high-risk procedure Ann. Thorac. Surg., August 1, 1998; 66(2): 396 - 401. [Abstract] [Full Text] [PDF]