MOBILE ATHEROMA OF THE AORTIC-ARCH IS AN UNDERESTIMATED SOURCE OF EMBOLIZATION

BACKGROUND: Mobile atheroma are associated with increased perioperativ e strokes in patients undergoing coronary artery bypass surgery. Perip heral embolization is an additional risk. Transesophageal echocardiogr aphy (TEE) accurately identifies mobile atheroma. Recent reports have discussed the possible influence of anticoagulant therapy in promoting peripheral cholesterol embolization. METHODS: Fourteen patients with mobile atheroma were treated with anticoagulation. A review of literat ure reporting results and complications of anticoagulation in the trea tment of this condition was compared with our recent experience. RESUL TS: Between 1994 and 1996, 14 patients with peripheral embolization an d mobile atheroma confirmed by TEE were anticoagulated. Clinical follo w-up between 6 to 30 months has demonstrated no further evidence of sy stemic embolization since anticoagulation. Furthermore, repeat TEE in 3 of 14 patients no longer visualized mobile atheroma. CONCLUSIONS: Mo bile atheroma are recognized sources for embolization. Patients with g eneralized atherosclerosis should be screened for this condition in ca ses of systemic embolization. Anticoagulation may have therapeutic con siderations in the management of this condition. (C) 1997 by Excerpta Medica, Inc.