AORTIC ATHEROMATOSIS AND RISKS OF CEREBRAL EMBOLIZATION

With the advent of transesophageal echocardiography, aortic atheromato sis has emerged as an important source of cerebral embolization. Mobil e atheromatous plaque in the ascending aorta and aortic arch has been shown to constitute a strong and independent risk factor in patients w ith stroke. In patients undergoing coronary bypass surgery, it is the single most important contributing factor to perioperative neurologic morbidity. Emboli originating in the heart, aorta, and proximal cerebr al vasculature have been observed intraoperatively in patients undergo ing coronary bypass surgery, especially when aortic clamps are release d. The constitution of these emboli is unclear, although an indetermin ate fraction undoubtedly represents dislodged atheromatous material. T he impact of such embolization in terms of neurologic outcome is curre ntly under investigation. Prevention of embolization from mobile aorti c atheroma in patients undergoing cardiac surgery may require modifica tion of surgical technique. Secondary prevention in patients with a hi story of embolization can only be determined once the natural history of such lesions is established. Copyright (C) 1996 by W.B. Saunders Co mpany.