SYSTEMIC EMBOLISM IN AORTIC-ARCH ATHEROMATOSIS

The role of aortic atheromatosis as a risk factor for systemic embolis m and its relationship to other potential sources of embolism was exam ined in 335 patients undergoing transoesophageal echocardiography for various clinical reasons. Multiple logistic regression analysis reveal ed a significant correlation between embolism and moderate (atheroma p rotruding less than 5 mm into the aortic lumen, grade 2) to complex (a theroma protruding at least 5 mm into the vessel lumen with or without mobile components, grade 3) atherosclerosis of the aortic arch. Odds ratios were 4.0 for grade 2 atheromatosis (95% CI 1.1-14.4; P<0.05) an d 9.7 for grade 3 atheromatosis (95% CI 1.5-61.0; P<0.05). Other signi ficant associations were found with cardiac thrombi (odds ratio 4.0, 9 5% CI 1.7 -9.3; P<0.005) and hypertension (odds ratio 1.8, 95% CI 1.0- 3.3; P<0.05). In a subset of 163 patients in whom results of an ultras ound examination were available, atherosclerosis of the carotid arteri es was another significant marker of embolism (odds ratio 2.0 95% CI 1 .2-3.3; P<0.01). In conclusion, aortic arch atheromatosis, which was p redominantly recognized in patients with cerebrovascular events of und etermined cause, seems to carry a risk of embolism that is comparable to cardiac and carotid atherosclerosis.