Innominate artery atheroma: A lesion seen with gadolinium-enhanced MR angiography and often missed by transesophageal echocardiography

Transesophageal echocardiography (TEE) is the procedure of choice for ident ifying aortic atheromas, which may result in stroke, transient ischemic att ack and peripheral embolization. However, because of anatomic constraints, the innominate artery may not be visualized. We investigated gadolinium-enh anced MR angiography (MRA) as an alternative technique for evaluation of su spected atheromas of the innominate artery. From a retrospective review of 520 examinations, we identified five patients who had innominate artery ath eromas diagnosed prospectively with gadolinium-enhanced MRA who also underw ent TEE within 1 month. A total of 10 innominate artery atheromas were demo nstrated on MRA; none of these were visualized on TEE. One patient had thre e atheromas, two patients had two atheromas and three patients had one athe roma. They ranged in size from 3 mm to 1.5 cm (mean 6.5 mm). One atheroma w as flat, two were filiform, and seven were protruding. Gadolinium-enhanced MRA is superior to TEE for the diagnosis of atheromas of the innominate art ery. In the setting of right cerebral or right arm embolization, when no so urce is seen in the arch on TEE, gadolinium-enhanced MRA should be consider ed. (C) 2001 Elsevier Science Inc. All rights reserved.