The Strokes - Lollapalooza 2010 by Kate Gardiner

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

GradesDescription
INormal to mild intimal thickening
IISevere thickening without protruding atheroma
IIIProtrudes < 5mm into lumen
IVProtrudes ≥ 5mm into lumen
VAny 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

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