Clinical characteristics, presentation, and outcomes in patients with thoracic aortic thrombus

Thoracic aortic thrombosis (TAT) is a rare, but important cause of arterial thromboembolism (ATE). There is a paucity of published data on TAT; therefore, risk stratification and management are challenging. In this study, we evaluated risk factors, presentation, and outcomes of patients diagnosed with TAT.

In this retrospective analysis, we analyzed data on all patients diagnosed with TAT by computed tomographic angiography between 2013 and 2024 at a single tertiary care center.

A total of 149 patients with an average age of 69.6 years (IQR 60.1-77.1) and 45.0% men were included. The most proximal thrombus location was the ascending aorta, arch, and descending aorta in 20.8%, 19.5%, and 59.7% of patients, respectively. Thrombus was attributed to atherosclerosis in 28.2% of patients, aneurysm in 32.9%, and other/unknown etiologies for the remainder of the cohort. Approximately 25% of patients presented with ATE. In a multivariable analysis, risk factors associated with ATE included age < 65 years (OR 7.9, p < 0.01), arch involvement (OR 3.7, p = 0.04), thrombus associated with atherosclerosis (OR 11.2, p = 0.042), and thrombus in nonaneurysmal/nonatherosclerotic aortas (OR 32.1, p < 0.01) in patients with CT-detected aortic thrombus. Patients with aneurysmal or atherosclerotic etiologies were less likely to be managed with anticoagulation (16% vs 61%, p < 0.01) and less likely to show thrombus regression or resolution (20% vs 68%, p < 0.01). Recurrent spontaneous embolic events occurred in three of 149 patients (median follow-up of 763 days; IQR 364-1559).

A significant proportion of patients with thoracic aortic thrombus present with ATE. Younger patients with arch thrombosis from nonaneurysmal/nonatherosclerotic etiologies are at the highest risk of ATE. Patients with nonaneurysmal/nonatherosclerotic etiologies of aortic thrombus were more likely to be treated with anticoagulation and show thrombus regression/resolution; however, the rate of recurrent spontaneous embolic events was low.