[Atheroma of the aortic arch and embolic risk]

Aortic atheroma, involving the ascending aorta and proximal aortic arch, is associated with an increased risk of cerebral and peripheral embolic complications and cardiovascular complications (acute myocardial infarction, vascular death, peripheral arterial ischaemia). These data were established on prospective, case-control, anatomical studies, which all used transoesophageal echocardiography as the reference diagnostic method. In the absence of an alternative radiological imaging technique, transoesophageal echocardiography describes the thickness of the plaque, its luminal extension, its more or less regular nature, and the presence of plaque calcifications and sessile or mobile thrombi. Some predisposing factors are associated with the thromboembolic risk of aortic athero-sclerosis: elevated plasma fibrinogen, presence of circulating anticoagulants, elevated plasma homocysteine. The mana-gement of these patients is purely empirical at the present time. Antiplatelet treatment is formally indicated following cerebral infarction. The presence of thrombosis on the atherosclerotic plaque constitutes an indication for anticoagulant therapy. The indication for thrombolysis and surgical resection of the aortic atheroma is anecdotal, in the absence of proof of their efficacy on large series. Progress in radiological and echocardiographic imaging, and complementary epidemiological studies should be able to more clearly define patient subgroups at higher risk. Aortic atherothrombosis was also recently associated with increased cardiovascular complications in patients with atrial fibrillation (SPAF III trial).