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Recognition and embolic potential of intraaortic atherosclerotic debris
D G Karalis1, K Chandrasekaran, M F Victor
1Likoff Cardiovascular Institute, Department of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania 19102.
Insights
Intraaortic atherosclerotic debris, often overlooked, is a significant source of systemic embolism. Transesophageal echocardiography can identify this debris, guiding treatment decisions and potentially preventing embolic events.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Atherosclerotic disease of the thoracic aorta is prevalent in elderly individuals and those with coronary artery disease.
- Embolization from thoracic aortic atherosclerotic debris is an underrecognized cause of systemic embolism.
- Identifying the source of embolism is crucial for appropriate patient management.
Purpose of the Study:
- To determine the prevalence, clinical significance, and embolic potential of intraaortic atherosclerotic debris.
- To evaluate the utility of transesophageal echocardiography in detecting this debris.
- To assess the association between debris characteristics and embolic events.
Main Methods:
- A prospective study involving 556 patients undergoing transesophageal echocardiography.
- Identification and characterization of intraaortic atherosclerotic debris.
- Correlation of debris presence and characteristics with embolic events and invasive aortic procedures.
Main Results:
- Intraaortic atherosclerotic debris was detected in 7% (38 of 556) of patients.
- Embolic events occurred in 31% (11 of 36) of patients with debris.
- Highly mobile, pedunculated debris was associated with a significantly higher incidence of embolism (73%) compared to layered, immobile debris (12%).
- Embolism incidence was 27% among patients undergoing invasive aortic procedures.
Conclusions:
- The thoracic aorta should be considered a potential source of systemic embolism.
- Transesophageal echocardiography is effective in detecting intraaortic atherosclerotic debris.
- Avoidance of invasive aortic procedures may be warranted in patients with identified intraaortic debris to minimize embolic risk.
Abstract:
Atherosclerotic disease of the thoracic aorta is common in the elderly and patients with clinical coronary artery disease. Although embolization can occur from atherosclerotic debris within the thoracic aorta, it is not commonly considered in the differential diagnosis of the source of a systemic embolism. In the current study, the prevalence, clinical significance and embolic potential of intraaortic atherosclerotic debris as detected by transesophageal echocardiography was determined. Intraaortic atherosclerotic debris was identified in 38 (7%) of 556 patients undergoing transesophageal echocardiography. An embolic event occurred among 11 (31%) of the 36 study patients with intraaortic atherosclerotic debris. The incidence of an embolic event was higher when the debris was pedunculated and highly mobile (8 [73%] of 11 patients) than when it was layered and immobile (3 [12%] of 25 patients) (p less than 0.002). Among 15 patients undergoing an invasive procedure of the aorta, the incidence of embolism was 27%. In conclusion, in a patient with an embolic event, the thoracic aorta should be considered as a potential source. Transesophageal echocardiography can reliably detect intraaortic atherosclerotic debris, and when it is identified, an invasive aortic procedure should be avoided if possible.