Aortic atheromas: current knowledge and controversies: a brief review of the literature

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Diagnostic Imaging

Background:

• Atheromatous disease of the aorta is a significant indicator of systemic vascular disease.
• It is associated with critical events such as ischemic stroke, peripheral embolization, and coronary artery disease.
• Transesophageal echocardiography is the standard imaging modality for evaluating aortic atheromas.

Purpose of the Study:

• To highlight discrepancies in the current grading of aortic atheromas.
• To identify specific atheroma characteristics associated with increased embolic risk.
• To underscore the need for evidence-based guidelines for medical management.

Main Methods:

• Review of existing literature on aortic atheroma assessment and clinical outcomes.
• Analysis of transesophageal echocardiogram findings in relation to embolic events.
• Evaluation of current therapeutic recommendations and evidence gaps.

Main Results:

• Atheromas exceeding 4 mm in thickness or exhibiting plaque rupture and mobile fragments are more frequently linked to peripheral embolic events.
• Significant variability exists in the interpretation and grading of aortic atheromas among clinicians.
• Limited high-quality randomized controlled trials exist to guide the medical management of aortic atheromas.

Conclusions:

• Specific features of aortic atheromas predict embolic risk, necessitating standardized assessment.
• Current medical management strategies lack robust clinical trial support.
• Further research, including large-scale randomized trials, is crucial to establish definitive treatment guidelines for aortic atheromas.