AORTIC ATHEROSCLEROTIC PLAQUES AS A SOURCE OF SYSTEMIC EMBOLISM

Objectives. Our study was designed to determine the significance of ao rtogenic embolism in an unselected autopsy collective. Background. Alt hough embolism arising from atherosclerotic plaques in the aorta has b een acknowledged, the role of aortic atheromatosis among other well kn own sources of embolism remains to be further clarified, Methods. We e xamined the proximal Dart of the arterial system with regard to the pr esence of atherosclerotic lesions as well as cardiac changes in 120 co nsecutive necropsy studies. Pathologic evidence of embolic events was recorded. Clinical and neuropathologic data were also surveyed in all patients, Results. Among atherosclerotic lesions, fibrous plaques (p < 0.05) and calcified (p < 0.0001) and ulcerated lesions (p < 0.0001) a s well as thrombi (p < 0.005) were observed significantly more frequen tly in the aortic arch and in the descending aorta than in the ascendi ng aorta, whereas fatty streaks sere distributed uni formly. In 40 (33 %) of the 120 patients, we found pathologic evidence of arterial embol ization. Multiple logistic regression analysis revealed a significant correlation between embolism and complicated atherosclerotic plaques i n the aortic arch (odds ratio [OR] 5.8, 95% confidence interval [CI] 1 .1 to 31.7, p < 0.05), severe ipsilateral carotid artery disease (OR 3 .1, 95% CI 3.1 to 45.3, p < 0.001) and atrial fibrillation (OR 3.5, 95 % CI 1.1 to 9.9, p < 0.05), Conclusions. Complicated atherosclerotic p laques in the aortic arch represent an independent risk factor for sys temic embolism similar to atrial fibrillation and severe atheroscleros is of the carotid arteries.