INTRAAORTIC DEBRIS AS A POTENTIAL SOURCE OF EMBOLIC STROKE

It is estimated that 10 to 20% of strokes are due to embolic phenomena.1 Patients with embolic strokes are often referred for echocardiographic evaluation to identify potential cardiac sources of emboli. Transthoracic echocardiography (TTE) is often unsuccessful in identifying an embolic source. Transesophageal echocardiography (TEE) has been shown to have a higher sensitivity for identifying sources of emboli, but in almost 50% of these patients, no cardiac source of emboli is found.2 However, the heart is only 1 possible source of emboli. For many years, atherosclerotic lesions in the carotids and ascending aorta have been known to generate debris that embolize distally to produce cerebral ischemia.3,4 TEE offers the ability to visualize the intimal surface of the thoracic aorta and allows detection of atherosclerotic lesions that may have the potential for embolization.5 This study examines whether patients with embolic strokes referred to find the cardiac source of emboli have complex aortic atherosclerotic plaques more often than do age-matched control subjects. © 1992.