Atherosclerosis of the thoracic aorta: from risk stratification to treatment

Abstract

Transesophageal echocardiography (TEE)-detected aortic arch plaques ≥4 mm in thickness are a potential source of arterial embolism and a strong and an independent risk factor for brain infarcts.1 Aortic arch plaques ≥4 mm are present in 1/3 of patients with cryptogenic stroke, which account for 1/3 of the total ischemic stroke population aged ≥60 years who had 1 or several vascular risk factors. The attributable risk of such plaques is 12.6% (95% confidence interval [CI] 7.6 to 17.6). Several longitudinal studies2–5 have shown an increased risk of recurrent brain infarcts and peripheral emboli (relative risk from 1.74 to 4.33,5). This means that the etiologic part and the overall vascular risk of aortic arch plaques ≥4 mm may be as high as nonvalvular atrial fibrillation or severe stenosis of internal carotid artery origin.1