Key result
Surgical excision of an ascending aortic thrombus adjacent to a cholesterol-rich plaque successfully treated multiple thromboembolic phenomena in a 40-year-old woman.
Case Report (n=1)
Surgical excision of a vulnerable ascending aortic plaque with an adjacent floating thrombus is an effective treatment to remove the underlying cause of multiple peripheral thromboembolisms.
May support surgical excision in rare ascending aortic thrombus cases; single report leaves open need for comparative data.
Ascending aortic thrombus causing thromboembolism in the absence of hyper-coagulable states is a rare occurrence. We present a case of a 40-year old healthy female smoker who presented with a 6-month history of three transient ischaemic attacks, hand pain and numbness despite being on dual anti-platelet therapy. Computed tomography revealed a mid-ascending aorta thrombus. She underwent ascending aorta replacement on cardiopulmonary bypass, but without the use of circulatory arrest. She recovered uneventfully. We identified a fresh thrombus adjacent to a soft, cholesterol-rich plaque as the culprit lesion. We advocate surgical excision of such lesions as the only way of removing the underlying cause of thromboembolism. In addition, rupture-prone aortic plaques may lead to a penetrating aortic ulcer or an intramural haematoma and ultimately aortic dissection.
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Sabetai et al. (2012) conducted a case report in Ascending aorta thrombus causing thromboembolism (n=1). Surgical excision and replacement of the ascending aorta was evaluated on Clinical recovery and prevention of further thromboembolism. Surgical excision of an ascending aortic thrombus adjacent to a cholesterol-rich plaque successfully treated multiple thromboembolic phenomena in a 40-year-old woman.
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