Complex Atheromatosis of the Aortic Arch: An Emerging Diagnosis in Cerebral Ischemia of Unknown Cause

Abstract

Complex atheromatosis of the aortic arch has been increasignly recognized as a cause of cerebral infarction in patients with stroke of uncertain etiology. The incorporation of transesophageal echocardiographic studies in routine clinical practice allows direct visualization of cardiac and vascular structures previously innaccessible, including atherosclerotic plaques in the aortic arch. Large atheromatous plaques, which protrude strikingly into the aortic arch lumen and have obvious mobile components are associated with a high probability of being the etiology of embolism. Aortic arch atheromatosis should be considered a dynamic process entailing a non-negligible risk of recurrent cardiovascular events. Therefore, adequate diagnosis and optimal treatment is mandatory for secondary prevention of cerebral ischemic infarction and progression of aortic arch atheromas.