My DDU point form notes on atheromatous disease of thoracic aorta…
The rest of my DDU notes are here.
Important problem
risk of stroke with cardiac surgery
cryptogenic stroke
risk of renal / limb embolization eg. post IABP
association with other disease of thoracic aorta
dissection
aneurysm
Risk factors
age
smoking
HT
Examination
surgical palpation grossly underestimates
TOE poor for distal ascending aorta
epiaortic becoming more common
suprasternal harmonic TTE may also see protruding arch atheroma
Influencing outcomes
minimizing aortic manipulation ↓ stroke risk 50%
?role of off pump eg. porcelain aorta
no RCTs?
Epiaortic
>7MHz transducer
usually phased array or linear
warm saline or gel inside sterile sheath
Atheroma
irregular thickening of ≥ 2mm
↑ echogenicity
± mobile components mainly thrombi
Features ↑ risk of stroke
these plaques termed complex
could just be markers not aetiological
thickness
≥ 4mm thick aortic arch plaques predict recurrent stroke (RR 3.8) per French Aortic Plaque in Stroke group (Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. The French Study of Aortic Plaques in Stroke Group. N Engl J Med 1996;334:1216–21)
ulceration
≥2mm in aortic plaque
mobile thrombi
Grading systems
Katz et al 1992 is commonly used newer ones exist
| Grades | Description |
|---|---|
| I | Normal to mild intimal thickening |
| II | Severe thickening without protruding atheroma |
| III | Protrudes < 5mm into lumen |
| IV | Protrudes ≥ 5mm into lumen |
| V | Any thickness with mobile component or components |
Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer FC, Kronzon I. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992;20:70–7
Cover image: The Strokes – Lollapalooza 2010 by Kate Gardiner
Tags: aorta DDU DDU Notes
