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[Atherosclerotic pathology of the aortic arch and cerebrovascular accidents]
1Service de Cardiologie, Université de Liège.
Insights
Transesophageal echocardiography reveals frequent aortic atherosclerosis in patients with embolism. This condition is a stroke recurrence risk factor, prompting a search for optimal evidence-based treatments.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Context:
- Transesophageal echocardiography (TEE) has improved visualization of aortic atherosclerosis.
- Atherosclerosis in the proximal aorta is linked to systemic and coronary atherosclerosis.
- This aortic involvement is a significant, independent risk factor for recurrent stroke.
Purpose:
- To define the optimal therapeutic approach for aortic atheromatous lesions.
- To address the lack of established treatment guidelines for this condition.
- To apply Evidence-Based Medicine principles for therapeutic decision-making.
Summary:
- Atherosclerosis of the initial, precarotid aorta is frequently observed via TEE in patients with cerebral or peripheral embolism.
- This finding highlights the aorta's role as a marker for generalized atherosclerosis and a predictor of stroke recurrence.
- Current therapeutic strategies for these aortic lesions remain debated, lacking clear clinical guidelines.
Impact:
- Provides a framework for evidence-based treatment selection for aortic atheromatous disease.
- Aims to reduce stroke recurrence by addressing a key underlying pathology.
- Contributes to the development of future clinical guidelines for managing proximal aortic atherosclerosis.
Abstract:
Over the last 10 years, transoesophageal echocardiography has allowed the visualisation of the particularly frequent atheromatous involvement of the initial part of the aorta in patients suffering from cerebral as well as peripheral embolism. Recent studies have shown that atherosclerosis of the initial, precarotid, part of the aorta is both a marker of general as well as coronary atherosclerosis and an important, accident independent risk factor of recurrence of stroke. The therapy of these aortic lesions is still currently under debate and there are no published guidelines about this issue in the literature. We therefore have applied the Evidence-Based Medicine information gathering method described earlier in this journal in order to better define the best therapeutic approach of this type of pathology.