[Atherosclerosis of the aortic arch: a possible new source of cerebral embolism].

Atherosclerosis of the aortic arch is common in individuals aged over 60. Plaques are very often ulcerated. The normal healing process results in the regular formation of thrombi on these ulcerations. A mural thrombus can thus be the source of systemic or cerebral emboli. Since the advent of transesophageal echocardiography, it has become possible to detect atherosclerotic plaques of the aortic arch. However, a causal relationship has never been demonstrated and it is possible that they may merely be a marker of atherosclerotic disease. Certain arguments suggest that the aortic arch may be a source of cerebral emboli: the high incidence of aortic mural thrombi and atheroma emboli during aortography or coronary arteriography, or cardiac surgery with extracorporeal circulation requiring cannulation of the aorta. Recent studies have also shown that plaques of the aortic arch are commoner in cases of cerebral infarction of unknown origin than when another potential cause is detected. The natural history of this type of lesion must be studied before any management attitude can be defined. In the present state of knowledge, the only possible advice is antiplatelet treatment and case-by-case consideration of anti-coagulant treatment, in particular in the presence of a mobile thrombus of the aortic arch.