CEREBRAL VASCULAR EVENTS IN PATIENTS WITH AORTIC ATHEROMA

The aorta is the most frequent site for atherosclerosis, and is more f requent than the internal carotids or cerebral arteries. Transesophage al echocardiography has made it possible to identify atheromatous lesi ons of the aortic arch which are situated before the branches to the n eck vessels and are capable of causing embolic cerebral events. These atheromatous plaques can be irregular, may protrude into the aortic lu men and sometimes have loose thrombus attached to them. The risk of st rokes and transient ischemic attacks appears to be higher when plaques are more than 4 mm in thickness and when mobile components are presen t. Atheroma in the ascending aorta and aortic arch is a significant ri sk factor for cerebral ischemia, independent of high-grade carotid ste nosis. Aortic atherosclerotic lesions should particulary be looked for in patients with a history of repeated peripheral and cerebral emboli sm, in whom no obvious embolic cause is found. A standard protocol for treatment of these potentially embolic aortic lesions has not get bee n agreed upon, but the use of antiplatelet drugs or vitamin-K antagoni sts treatment should be considered.