Malaterre H R, Daver L
Service de Médecine Interne, CHRU La Conception, Marseille.
Ann Med Interne (Paris). 1996;147(5):347-51.
The aorta is the most frequent site for atherosclerosis, and is more frequent than the internal carotids or cerebral arteries. Transesophageal echocardiography has made it possible to identify atheromatous lesions of the aortic arch which are situated before the branches to the neck vessels and are capable of causing embolic cerebral events. These atheromatous plaques can be irregular, may protrude into the aortic lumen and sometimes have loose thrombus attached to them. The risk of strokes and transient ischemic attacks appears to be higher when plaques are more than 4 mm in thickness and when mobile components are present. Atheroma in the ascending aorta and aortic arch is a significant risk factor for cerebral ischemia, independent of high-grade carotid stenosis. Aortic atherosclerotic lesions should particularly be looked for in patients with a history of repeated peripheral and cerebral embolism, in whom no obvious embolic cause is found. A standard protocol for treatment of these potentially embolic aortic lesions has not yet been agreed upon, but the use of antiplatelet drugs or vitamin-K antagonists treatment should be considered.
主动脉是动脉粥样硬化最常见的部位，比颈内动脉或脑动脉更常见。经食管超声心动图能够识别主动脉弓的动脉粥样硬化病变，这些病变位于颈部血管分支之前，能够引发栓塞性脑事件。这些动脉粥样硬化斑块可能不规则，可能突入主动脉腔，有时还附着有松散的血栓。当斑块厚度超过4毫米且存在可移动成分时，中风和短暂性脑缺血发作的风险似乎更高。升主动脉和主动脉弓的动脉粥样硬化是脑缺血的一个重要危险因素，与重度颈动脉狭窄无关。对于有反复外周和脑栓塞病史但未发现明显栓塞原因的患者，尤其应检查是否存在主动脉粥样硬化病变。目前尚未就这些潜在栓塞性主动脉病变的标准治疗方案达成共识，但应考虑使用抗血小板药物或维生素K拮抗剂进行治疗。
