Document Detail


Aortic arch atheroma.
MedLine Citation:
PMID:  18706048     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Severe atheroma of the aortic arch has now been established as an important risk factor and mechanism for stroke and peripheral embolism. The odds ratio for stroke or peripheral embolism in patients with severe arch atheroma is greater than four, and for mobile atheroma it is greater than 12. The prevalence of severe arch atheroma among patients presenting with acute ischaemic stroke, at over 20%, is in the same order as that of atrial fibrillation and carotid atherosclerosis. In patients with ischaemic stroke for which no cause has been identified, it is reasonable to determine as to whether they have severe arch atheroma by performing a transoesophageal echocardiogram. Recurrent stroke is common in patients with aortic arch atheroma that are thicker than 4 mm or with mobile components, particularly in the elderly, cigarette smokers, and those with hypertension or diabetes. Patients found to have severe atheroma are at high risk of recurrent events (14.2% per year) and may, therefore, need an aggressive secondary prevention strategy. Currently, there is uncertainty as to what this should be, but either combination antiplatelet therapy (aspirin plus clopidogrel) or anticoagulation with warfarin (target INR 2.0-3.0) are commonly used. Which of these is most effective will be evident after the completion of the aortic arch related cerebral hazard trial.
Authors:
Jorge A Zavala; Pierre Amarrenco; Stephen M Davis; Elizabeth F Jones; Dennis Young; Malcolm R Macleod; Laura L Horky; Geoffrey A Donnan
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  International journal of stroke : official journal of the International Stroke Society     Volume:  1     ISSN:  1747-4949     ISO Abbreviation:  -     Publication Date:  2006 May 
Date Detail:
Created Date:  2008-08-18     Completed Date:  2008-11-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101274068     Medline TA:  Int J Stroke     Country:  England    
Other Details:
Languages:  eng     Pagination:  74-80     Citation Subset:  IM    
Affiliation:
National Stroke Research Institute, Heidelbergh Heights, Victoria, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aorta, Thoracic / pathology,  ultrasonography*
Aortic Diseases / complications,  pathology,  prevention & control,  ultrasonography*
Atherosclerosis / complications,  pathology,  prevention & control,  ultrasonography*
Cadaver
Echocardiography, Transesophageal
Humans
Intracranial Embolism / epidemiology,  pathology
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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