PROTRUDING ATHEROMAS IN THE THORACIC AORTA AND SYSTEMIC EMBOLIZATION

Objective: To determine whether protruding atheromas in the thoracic aorta are a risk factor for systemic embolization. Design: Case-control study. Setting: A referral hospital. Patients: A total of 122 patients with a history of stroke, transient ischemic attack, or peripheral emboli and an equal number of age- and sex-matched control patients. Measurements: Evaluation using transesophageal echocardiography was done in case patients to detect protruding atheromas in the thoracic aorta and in control patients for cardiac indications other than emboli. Main Results: Matched logistic regression showed that the presence of protruding atheromas was strongly related to the occurrence of embolic symptoms (odds ratio, 3.2; 95% Cl, 1.6 to 6.5; P < 0.001). Furthermore, atheromas with mobile components were present only in case patients. When known risk factors for stroke (hypertension and diabetes) were added to the model, the presence of protruding atheromas remained an independent risk factor for embolic symptoms (odds ratio, 3.8). Hypertension was also independently associated with embolic symptoms (odds ratio, 2.7), but diabetes was not (odds ratio, 1.0). Conclusion: Protruding atheromas in the thoracic aorta can be detected by transesophageal echocardiography and should be considered as a cause of strokes, transient ischemic attacks, and peripheral emboli.