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Embolism from aortic plaque: Thromboembolism

Author
Warren J Manning, MD
Section Editors
Emile R Mohler III, MD
Jose Biller, MD, FACP, FAAN, FAHA
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Aortic atherosclerotic plaques are a manifestation of systemic atherosclerosis (image 1 and movie 1). They are associated with risk factors for atherosclerotic disease, and are more common in patients with coronary artery disease and in older individuals [1-5]. In addition, aortic atherosclerotic plaques are an important cause of systemic embolization [6-9]. Embolic events in the setting of aortic atherosclerosis can occur spontaneously or they can be induced by mechanical interventions including guidewire/catheter manipulation during cardiac catheterization, intraaortic balloon pulsations, and vessel clamping/manipulations during cardiac and vascular surgery [10,11]. The risk of embolism in patients with aortic atherosclerosis is markedly increased for plaques that are mobile and/or protruding, particularly if >4 mm in thickness.  

The clinical features, prevention, and treatment of thromboembolism from aortic plaques will be reviewed here, with a focus on stroke, which is the most common clinical manifestation. Atheroembolism is discussed separately. (See "Embolism from atherosclerotic plaque: Atheroembolism (cholesterol crystal embolism)".)

THROMBOEMBOLISM VERSUS ATHEROEMBOLISM

Thromboembolism from aortic plaques is common, whereas cholesterol crystal embolization is fairly rare. Although there is some overlap, these disorders have characteristic distinguishing features:

Thromboembolism may occur when an atherosclerotic plaque from large or medium arteries becomes unstable, and superimposed thrombi embolize. The thromboemboli tend to be single, and tend to lodge in small or medium arteries, resulting most often in stroke or transient ischemic attack [6-9,12]. Limb ischemia (upper or lower extremity), renal infarction, intestinal ischemia, or ischemia of other organs can also occur [9,13].

The term atheroembolism is used synonymously with cholesterol crystal embolism, cholesterol embolism or micro-atheroembolism. These terms refer to arterio-arterial embolism of fragments of atheromatous material originating from an atherosclerotic plaque of the aorta or occasionally other arteries. The result of such embolization is tissue and organ damage produced by multiple small artery occlusions (eg, "blue toe" syndrome, retinal ischemia, renal failure, livedo reticularis, and intestinal infarction). (See "Embolism from atherosclerotic plaque: Atheroembolism (cholesterol crystal embolism)".)

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Feb 12 00:00:00 GMT+00:00 2015.
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