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| A PICTURE IS WORTH A THOUSAND WORDS |
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| Year : 2023 | Volume
: 24
| Issue : 2 | Page : 122-123 |
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Aortic thrombi complicated by stroke
Abdel Haleem Shawky Hamada, Smitha Anilkumar
Department of Non-invasive Cardiology, Hamad Medical Corporation, Heart Hospital, Doha, Qatar
| Date of Submission | 22-Feb-2023 |
| Date of Acceptance | 22-Feb-2023 |
| Date of Web Publication | 24-Mar-2023 |
Correspondence Address:
Dr. Abdel Haleem Shawky Hamada
Department of Non-invasive Cardiology, Hamad Medical Corporation, Heart Hospital, Doha
Qatar
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/heartviews.heartviews_14_23
How to cite this article:
Hamada AH, Anilkumar S. Aortic thrombi complicated by stroke. Heart Views 2023;24:122-3 |
A50-year-old female patient presented with a posterior cerebellar stroke which was proved by magnetic resonance imaging brain as bilateral cerebellar infarctions, mainly involving the left cerebellar hemisphere.
Magnetic resonance angiography brain showed a significant proximal left vertebral artery stenosis with near-total occlusion of its distal part as well.
The risk factors include mild hypercholesteremia with a history of two miscarriages. Referred for transesophageal echocardiography (TEE) to rule out cardiac sources of thrombi. The TEE showed multiple fresh thrombi in the aorta mainly at the arch and at the origin of the left subclavian artery [Figure 1]a, [Figure 1]b, [Figure 1]c. | Figure 1: (a and b) TEE short-axis and long-axis views of the aortic arch showing two highly mobile pedunculated fresh thrombi (yellow arrows). (c) Modified short-axis TEE view of the aortic arch (40°) showing the origin of the LSA (blue arrow) with one fresh thrombus (yellow arrow) seen just at the orifice of the LSA. TEE: Transesophageal echocardiography, LSA: Left subclavian artery
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The patient was started on heparin and warfarin for 2 weeks and a follow-up TEE showed complete clearance of the thrombi [Figure 2]a and [Figure 2]b. | Figure 2: (a and b) TEE short-axis and long-axis views of the aortic arch showing clearance of previously mentioned thrombi after 2 weeks of anticoagulation. TEE: Transesophageal echocardiography
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The patient was further investigated for hypercoagulable state and thrombophilia defects. Her Protein C, Protein S, and antithrombin III were normal. Serum fibrinogen was mildly elevated, and the antiphospholipid antibody turned out to be positive.
Approximately 20% of people younger than 50 who have a stroke have antiphospholipid syndrome, and approximately 10%–15% of individuals who experience recurrent miscarriages have antiphospholipid syndrome. Aortic arch atheroma (AAA) is a frequent finding in patients with ischemic stroke.[1]
TEE is considered a gold standard for its detection. The prevalence of AAA increases with age. In patients aged 25–34 years, it is 4.9%; in 35–44 years is 12.1%; in between 45 and 54 years (our patient) is 22.5%; and in those with 55–64 years, up to 33%.[2]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Suzuki M, Furuya K, Ozawa M, Miura K, Ozawa T, Matsuzono K, et al. Complex aortic arch atherosclerosis in acute ischemic stroke patients with non-valvular atrial fibrillation. J Atheroscler Thromb 2021;28:776-85.  |
| 2. | Kim SW, Kim YD, Chang HJ, Hong GR, Shim CY, Chung SJ, et al. Different infarction patterns in patients with aortic atheroma compared to those with cardioembolism or large artery atherosclerosis. J Neurol 2018;265:151-8. |
[Figure 1], [Figure 2]
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