aortic atheroma

Pathology

• intimal thickening
• calcification may actually confer stability to atheroma
• sometimes ulceration, destablization, development of mobile projections & embolization

Diagnostic procedures

• transesophageal echocardiogram
  • identify atheromas in the ascending aorta or aortic arch with a mobile component (see Complications belowz0
  • no definitive medical or surgical management that has been shown to reduce incidence of aortic complications or thromboembolic events due to aortic atheromas

Radiology

• CT of abdomen & thorax

Complications

• aortic atheromas >= 4 mm in thickness in the ascending aorta or aortic arch increase the risk of recurrent embolic stroke
  • atheromas with a mobile component are more likely to be associated with thromboembolism
• atheromas in the descending aorta are markers of atherosclerosis & cardiovascular risk, but do not seem to be associated with pathologic embolism

Management

• life style modification, risk factor reduction*
  • smoking cessation
  • heart-healthy diet
  • aerobic exercise
• antiplatelet agent: aspirin or clopidogrel
  • warfarin may be superior to aspirin for prevention of stroke
• statin
• control blood pressure

* MKSAP dismisses diet & lifetyle modification; advocates aggressive treatment with anti-platelet agent & statin

More general terms

• atherosclerosis
• atheroma (atherosclerotic plaque)

More specific terms

• penetrating aortic atherosclerotic ulcer