Complex Aortic Arch Atheromas: A New Potential Source of Brain Embolism, Frequency, Risk Factors And Management.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 17, Issue 2
Abstract
Background: Significant aortic arcliatheromas (>4mm thick) have been identified as one of the most powerflil independent risk factors for ischemic strokes in western patients >60 years of age, but there is little published literature on frequency of aortic atheromas in Indian population. Material and Methods: The current study was aimed at assessing the frequency and risk factors of significant aortic arch atheroma in stroke patients attending a tertiary care center in south India, whose stroke mechanism was not clear even after detailed clinical assessment, and investigations including Carotid Doppler, Magnetic resonance imaging and 2D Transthoracic echocardiography. Results: Out of 297 consecutive patients of ischemic stroke, seen between 1st January 2001 and 31st December 2001, Transesophageal Echocardiography (TEE) was performed in 85 patients with stroke of unknown mechanism. Eighteen patients (21%) were discovered to have significant and complex aortic arch atherosclerosis as the underlying cause of their stroke. The men: women ratio was 15:3 and the mean age was 54.28±12.41. Four were protruding but immobile, whereas 14 were mobile atheromas. Two patients had superadded ulcerations. Nine (50%) had hypertension, 6 (33%) had diabetes, 4 (22%) had history of smoking and 1 (5%) had alcoholism. There was no significant difference between the frequency of these risk factors between aorto-embolic and other stroke subtypes. Regarding the clinical features, 6 patients had left hemiparesis, 6 had right hemiparesis, 2 had ataxia, 2 had dementia and 1 had hemianopia. Conclusions: To conclude, aortic arch atherosclerosis was found to contribute to a significant number of stroke patients in a south Indian tertiary care center. All stroke patients with unknown mechanism should be subjected to TEE to detect aortic atheroma as this has therapeutic implications. Key words: Aortic Arch, Atheromas, Embolism, Stroke
Authors and Affiliations
1Dr. B. Srinivasulu, 2Dr. C. S. K. Prakash, 3Dr. Lanka Krishna, 4Dr. A. K Meena, Dr. S. Kaul
Keywords
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