Abstract
Atherosclerosis is a systemic pathologic process, may involve aorta and is important cause of systemic embolization. The risk of embolism is increased for mobile and complex aortic plaques that are >4 mm thick. The most common manifestations are stroke, transient ischemic attack (TIA) and peripheral embolization. Imaging modalities used include transesophageal echocardiogram (TEE), CT angiography and magnetic resonance angiography (MRA). The mainstays of medical treatment are antiplatelets and statin. The role of anticoagulation is reserved for plaques with thrombotic component.There were two patients who presented with large acute ischemic stroke with high grade, floating aortic arch thrombus and complex aortic arch plaques. In one of cases, after 10-day follow-up CT aortic angiography showed completely resolved thrombus after being treated with IV tissue plasminogen activator (TPA) followed by low molecular weight heparin (LMWH). The risk of embolism depends on size of aortic plaques and mobility. TEE is modality of choice for thoracic aortic plaques. Aortic plaques >4 mm are independent predictors of recurrent ischemic stroke. There are limited data available for off-label use of intravenous thrombolysis and mechanical thrombectomy (MT) in presence of aortic arch thrombus in acute ischemic strokes. These two case reports help in recognition of aortic arch complex plaques as independent risk factor for recurrent stroke. The right patients may consider about the use of intravenous alteplase and MT performed via trans-brachial access after excluding aortic dissection and aneurysm. In future, multicenter, randomized controlled trials will be required for safety of IV TPA and MT.
Highlights
Stroke is the second most common etiology of mortality and morbidity [1, 2]
Aortic atherosclerotic plaques are an important cause of systemic embolization [8]
The risk of embolism in patients with aortic atherosclerosis is increased for plaques that are mobile and/or protruding, if >4 mm in thickness
Summary
Stroke is the second most common etiology of mortality and morbidity [1, 2]. A 66-year-old lady with diabetes mellitus (DM) and hypertension (HTN), presented with complaints of slurred speech and right-sided weakness at 0600h morning She woke up at 0540h and was seen normal on the day of admission. Ten days after the stroke, repeat aortic contrast CT angiography showed diffuse atherosclerotic changes in the aortic arch, descending thoracic aorta and abdominal aorta These atherosclerotic changes were most severe at the distal part of the abdominal aorta which showed circumferential mural thickening and calcifications extending to both common iliac arteries causing mild luminal narrowing. Repeat CT scan head after 24 hours showed large left MCA full territory and a small right frontal parafalcine acute ischemic stroke.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
