PROTRUDING ATHEROMAS OF THE AORTIC-ARCH IN SYMPTOMATIC PATIENTS WITH CAROTID-ARTERY DISEASE

Protruding aortic arch atheromas are associated with otherwise unexpla ined strokes and transient ischemic attacks. Therefore aortic atheroma s also may be important in patients with carotid artery disease. Forty -five patients with greater than or equal to 50% carotid stenosis and stroke or transient ischemic attack within 6 weeks underwent transesop hageal echocardiographic examination (TEE). They were matched for age, sex, and hypertension with 45 control subjects who had also had a rec ent cerebral event but in whom significant carotid stenosis was absent . Protruding aortic arch atheromas were present in 17 (38%) of 45 pati ents with carotid disease and only 7 (16%) of 45 of control subjects ( p = 0.02). Mobile atheromas (with the greatest embolic potential) were present almost exclusively in case patients, 6 (13%) of 45, versus 1 (2%) of 45 control subjects (p = 0.05). Case patients with mobile athe romas had the most severe carotid stenosis (greater than or equal to 8 0%). Cerebral symptoms were discordant with the side of the carotid st enosis in 10 case patients, and 4 had atheromas. In conclusion, protru ding atheromas of the aortic arch are present in significant numbers o f symptomatic patients with carotid artery disease. These atheromas ma y represent an additional cause of symptoms in patients with carotid s tenosis. TEE to look for protruding aortic atheromas may be considered in patients with neurologic events despite the presence of significan t carotid stenosis, especially if the symptoms are discordant with the side of carotid stenosis.