[The aortic arch as an embolism source for cerebral infarcts]

Area of Science:

• Cardiovascular Medicine
• Neurology
• Radiology

Background:

• Atherosclerotic plaques in the aortic arch are a recognized, yet often overlooked, source of cerebral emboli.
• Cryptogenic stroke, stroke of unknown origin, necessitates thorough investigation of potential embolic sources.
• Transesophageal echocardiography (TEE) is a key diagnostic tool for visualizing aortic arch pathology.

Observation:

• Seven patients with cerebral infarction were diagnosed with atherosclerotic plaques in the aortic arch via TEE.
• All patients presented with common cardiovascular risk factors including hypertension, diabetes, hypercholesterolemia, and smoking.
• Plaque intraluminal protrusion varied significantly, ranging from 5 to 24 millimeters.

Findings:

• Aortic arch atheromas were identified as a direct cause of cerebral infarction in the studied cohort.
• Concurrent carotid artery disease was noted in four patients, and one had atrial fibrillation with left atrial spontaneous echo contrast.
• The size and morphology of aortic arch plaques, particularly mobile and pedunculated atheromas, correlate with embolic potential.

Implications:

• The aortic arch should be considered a critical embolic source in cryptogenic stroke, even in the presence of carotid or cardiac disease.
• TEE is crucial for identifying aortic arch atheromas as a cause of stroke.
• Anticoagulation therapy is recommended for patients with mobile and pedunculated aortic arch atheromas to prevent recurrent embolic events.