[Cerebrovascular complication caused by aortic atheroma]

The aorta is the most frequent site for atherosclerosis, and is more frequent than the internal carotids or cerebral arteries. Transesophageal echocardiography has made it possible to identify atheromatous lesions of the aortic arch which are situated before the branches to the neck vessels and are capable of causing embolic cerebral events. These atheromatous plaques can be irregular, may protrude into the aortic lumen and sometimes have loose thrombus attached to them. The risk of strokes and transient ischemic attacks appears to be higher when plaques are more than 4 mm in thickness and when mobile components are present. Atheroma in the ascending aorta and aortic arch is a significant risk factor for cerebral ischemia, independent of high-grade carotid stenosis. Aortic atherosclerotic lesions should particularly be looked for in patients with a history of repeated peripheral and cerebral embolism, in whom no obvious embolic cause is found. A standard protocol for treatment of these potentially embolic aortic lesions has not yet been agreed upon, but the use of antiplatelet drugs or vitamin-K antagonists treatment should be considered.