MASSIVE AORTIC ATHEROMA AS CAUSE OF ISCHEMIC STROKE

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2024-09-01 DOI:10.1016/j.ajpc.2024.100753
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Abstract

Therapeutic Area

CVD Prevention – Primary and Secondary

Case Presentation

A 78-year-old-male was referred for assessment of the etiology of a symptomatic ischemic stroke in the right cerebellum. Vascular imaging including CT angiogram of the head and neck as well as prolonged electrocardiogram monitoring did not reveal a cause of his stroke.
A transesophageal echocardiogram (TEE) demonstrated no embolic source in the cardiac chambers and no intra-atrial shunt was identified. However, upon inspection of the descending thoracic aorta, a large atheroma was visualized measuring 2 cm in diameter and 0.7 cm thick (Figure). This finding led to a CT to further characterize this lesion. CT demonstrated non-calcified atherosclerotic plaque in the descending thoracic aorta which was determined to be the likely etiology of the stroke.
The identification of significant atherosclerotic plaque led to aggressive secondary prevention with the addition of aspirin 81 mg and high-intensity statin therapy. The patient's LDL cholesterol decreased from 120 mg/dL prior to the event to 42 mg/dL 12 weeks after initiating high-intensity statin therapy. At 1-year follow-up the patient has had no neurologic events and is tolerating therapy well.

Background

After a cerebrovascular accident is diagnosed, testing is warranted to identify the etiology. Unless a known etiology is identified, testing typically includes laboratory studies, prolonged ambulatory cardiac monitoring, imaging of the head and neck vessels, and imaging of the cardiac structures. Cardiac imaging typically begins with a transthoracic echocardiogram (TTE). However, TTE lacks the spatial resolution to identify atheromatous disease in the descending thoracic aorta. Thus, further imaging with TEE is often necessary for imaging the aorta and to rule out an intra-cardiac shunt.
After the etiology of a stroke is defined, management focuses on aggressive risk factor modification. Recent guidelines recommend initiating high-intensity statin therapy with a goal of reducing LDL to reduce the risk of future sequela related to atherosclerosis. In this case, aggressive antiplatelet and lipid lowering therapy was initiated with a significant reduction in the patient's LDL cholesterol.

Conclusions

This case represents a massive descending aortic atheroma, identified on TEE, as the cause of an ischemic stroke that led to aggressive secondary risk factor modification.
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大面积主动脉粥样斑块是缺血性中风的病因
治疗领域心血管疾病的一级和二级预防病例介绍一位 78 岁的男性患者因右侧小脑无症状缺血性中风转诊接受病因评估。经食道超声心动图(TEE)显示心腔内无栓塞源,也未发现心房内分流。然而,在检查降胸主动脉时,发现一个直径 2 厘米、厚 0.7 厘米的巨大动脉粥样斑块(图)。根据这一发现,患者接受了 CT 检查,以进一步确定病变的特征。CT 显示降胸主动脉有未钙化的动脉粥样硬化斑块,这可能是导致中风的病因。患者的低密度脂蛋白胆固醇从发病前的 120 毫克/分升降至开始高强度他汀治疗 12 周后的 42 毫克/分升。背景脑血管意外确诊后,需要进行检查以确定病因。除非确定了已知的病因,否则检查通常包括实验室检查、长时间非卧床心脏监护、头颈部血管成像和心脏结构成像。心脏成像通常从经胸超声心动图(TTE)开始。但是,TTE 缺乏空间分辨率,无法识别降主动脉中的粥样病变。因此,通常需要进一步通过 TEE 对主动脉进行成像,以排除心内分流。最近的指南建议开始高强度他汀类药物治疗,目标是降低低密度脂蛋白,以减少未来与动脉粥样硬化相关的后遗症风险。在本病例中,患者接受了积极的抗血小板和降脂治疗,低密度脂蛋白胆固醇显著降低。
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
6.60
自引率
0.00%
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0
审稿时长
76 days
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