domingo, 16 de janeiro de 2011

AVC x Placa aterosclerótica em Aorta Torácica Descendente - by Fábio Soares

   Dr. Leandro Serafim, enviou-me um caso (há algum tempo, é verdade), e vive dizedo que eu não o posto aqui no blog. Então, aí vai:
   Trata-se de um senhor idoso, com passado de AVE isquêmico, com Doppler de Carótidas e Vertebrais sem aterosclerose signficativa, e ecocardiograma com alterações prórpisas da idade. Chamava a atenção placa aterosclerótica ulcerada na transição do arco aórtico para a aorta torácica descendente.




Complex Plaques in the Proximal Descending Aorta An Underestimated Embolic Source of Stroke

Andreas Harloff, MD ; Jan Simon ; Stefanie Brendecke ; Dawit Assefa, MD ; Thomas Helbing, MD ; Alex Frydrychowicz, MD ; Johannes Weber, MD ; Manfred Olschewski, MS ; Christoph Strecker, MD ; Jürgen Hennig, PhD ; Cornelius Weiller, MD Michael Markl, PhD


From Department of Neurology (A.H., J.S., S.B., C.S., C.W.), Department of Cardiology and Angiology (D.A., T.H.), Department of Diagnostic Radiology Medical Physics (A.F., J.H., M.M.), Department of Neuroradiology (J.W.), University Hospital Freiburg, Freiburg, Germany; Institute of Medical Biometrics and Statistics (M.O.), University of Freiburg, Freiburg, Germany.
Stroke June 2010
Background and Purpose— To investigate the incidence of retrograde flow from complex plaques (4-mm-thick, ulcerated, or superimposed thrombi) of the descending aorta (DAo) and its potential role in embolic stroke.

Methods— Ninety-four consecutive acute stroke patients with aortic plaques 3-mm-thick in transesophageal echocardiography were prospectively included. MRI was performed to localize complex plaques and to measure time-resolved 3-dimensional blood flow within the aorta. Three-dimensional visualization was used to evaluate if diastolic retrograde flow connected plaque location with the outlet of the left subclavian artery, left common carotid artery, or brachiocephalic trunk. Complex DAo plaques were considered an embolic source if retrograde flow reached a supra-aortic vessel that supplied the territory of visible acute and embolic retinal or cerebral infarction.

Results— Only decreasing heart rate was correlated (P<0.02) with increasing flow reversal to the aortic arch. Retrograde flow from complex DAo plaques reached the left subclavian artery in 55 (58.5%), the left common carotid artery in 23 (24.5%), and the brachiocephalic trunk in 13 patients (13.8%). Based on routine diagnostics and MRI of the ascending aorta/aortic arch, stroke etiology was determined in 57 and cryptogenic in 37 patients. Potential embolization from DAo plaques was then identified in 19 of 57 patients (33.3%) with determined and in 9 of 37 patients (24.3%) with cryptogenic stroke.



Conclusions— Retrograde flow from complex DAo plaques was frequent in both determined and cryptogenic stroke and could explain embolism to all brain territories. These findings suggest that complex DAo plaques should be considered a new source of stroke.

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