ATHEROMATOSIS OF THE AORTIC-ARCH AS AN OCCULT SOURCE OF MULTIPLE SYSTEMIC EMBOLI

Atheroemboli are a well-known cause of arterial of microcirculatory obstruction, especially after a catheter is passed through the abdominal or thoracic aorta. We previously reported the cases of three patients with embolization in whom transesophageal echocardiography showed a new finding: protruding atherosclerotic masses, with mobile components, in the aortic arch and descending thoracic aorta. We subsequently evaluated the currently reported patient, who had had four cerebral and peripheral emboli within a short period. She also had protruding plaque in her aortic arch, which was removed surgically because of her repeated episodes. Pathologic examination showed it to be atherosclerotic plaque with superimposed thrombus. We believe that this is the first time that aortic arch endarterectomy has been done as a result of this new transesophageal echocardiographic finding and that this process may be responsible for embolization in some patients in whom the cause had been previously unexplained.