Aortic Thrombus: A Rare Cause of Ischemic Stroke

Aortic thrombus is a rare and relatively underrecognized cause of peripheral embolic events, particularly ischemic stroke. It affects the elderly in most cases. It's a retrospective case series study carried out in the Neurology Department of the Hassan II University Hospital of Fez, Morocco, to analyze the epidemiological, clinical, therapeutic, and outcome data of aortic thrombus as an etiology of ischemic stroke. Eight patients were included in this study, with a mean age of 65.87 years. They were admitted with an average delay of 12 hours and 56 minutes from the onset of the neurological symptoms. The imaging protocol consisted of a non-contrast CT scan combined with CT Angiography of the polygon of Willis and supra-aortic trunks. The aortic arch was the predominant site of thrombus. Treatment consisted of curative anticoagulation for all patients, whose continuation depends on the results of control imaging. The main etiology of aortic thrombus is represented by atherosclerosis, alongside other etiologies such as thrombophilia, infectious aortitis, particularly syphilitic aortitis and antiphospholipid syndrome. The main site is the transverse thoracic aorta and the isthmus. The optimal therapeutic approach remains controversial due to the lack of large prospective series in the literature and largely relies on curative anticoagulation. The use of thrombolysis is debated due to the risk of induced peripheral emboli. Thrombectomy is reserved for specific cases.