Systemic embolism in aortic arch atheromatosis

The role of aortic atheromatosis as a risk factor for systemic embolism and its relationship to other potential sources of embolism was examined in 335 patients undergoing transoesophageal echocardiography for various clinical reasons. Multiple logistic regression analysis revealed a significant correlation between embolism and moderate (atheroma protruding less than 5 mm into the aortic lumen, grade 2) to complex (atheroma protruding at least 5 mm into the vessel lumen with or without mobile components, grade 3) atherosclerosis of the aortic arch. Odds ratios were 4.0 for grade 2 atheromatosis (95% CI 1.1-14.4; P < 0.05) and 9.7 for grade 3 atheromatosis (95% CI 1.5-61.0; P < 0.05). Other significant associations were found with cardiac thrombi (odds ratio 4.0, 95% CI 1.7-9.3; P < 0.005) and hypertension (odds ratio 1.8, 95% CI 1.0-3.3; P < 0.05). In a subset of 163 patients in whom results of an ultrasound examination were available, atherosclerosis of the carotid arteries was another significant marker of embolism (odds ratio 2.0, 95% CI 1.2-3.3; P < 0.01). In conclusion, aortic arch atheromatosis, which was predominantly recognized in patients with cerebrovascular events of undetermined cause, seems to carry a risk of embolism that is comparable to cardiac and carotid atherosclerosis.